Job Description
Explore opportunities with WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will be part of a team who shares your passion for helping people achieve improved health outcomes. Practice Support Specialist (PSS) serves as a clinical liaison between contracted primary care practices and WellMed contracted clinical operations. This role is designed to drive value-based care performance and reduce avoidable utilization through proactive patient outreach, coordinated clinical interventions, and improved provider engagement. The PSS supports practices in managing high-risk patients and implementing population health strategies aligned with organizational priorities. This role reports to the Provider Relations Leader and works in a matrixed leadership environment. Clinical activities will occur under the direction of the WellMed Senior Medical Director and in accordance with Company protocols, established nursing practice standards, and the relevant state regulatory requirements. The role is field-based with an expected travel requirement of 75-85% to contracted provider offices.
Manage patient census across assigned practices, focusing on high-risk and high-cost cohorts
ER visits, Admits/K, Readmits/K, SNF/ASC/hospital usage, and palliative care engagement
Serve as a liaison between PCPs, hospitalists, specialists, and care management programs to ensure coordinated care delivery
Support practices in implementing contingency plans for high-risk patients (HF, COPD), including documentation of advanced directives and care bundle elements
Conduct weekly touchpoints with the medical director dyad partner to review admissions and determine escalations to contracted providers
In partnership with PBM and Medical Director team, analyze utilization and performance data to identify trends and root causes
Develop action plans aligned with market goals (quality, cost, coding)
Ensure monthly visits for Band 5 and other high-risk cohorts per prioritization list
Facilitate timely follow-up for hospital discharges and transitions of care
Conduct weekly 'tuck-in calls' to high-risk members
Support referral management aligned with preferred specialist strategy
Facilitate Tier 1 Cardiology/HF clinic referrals and support optimization of guideline-directed medical therapy (GDMT)
Quality & Risk Adjustment Support
Provide education and baseline support for risk adjustment documentation before coder SME engagement
Drive timely closure of care gaps (medication adherence, preventive screenings, HEDIS/STAR measures)
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
4+ years in any combination of provider relations, network management
~ Experience with Medicare Advantage, HEDIS, STAR, CMS reimbursement models, risk adjustment
~ Proven solid analytics, communication, relationship-building, and proficiency in Microsoft Office
~ Ability to travel extensively (up to 75-85%)
~ Bachelor's degree in Business or Healthcare Administration
Experience in value-based care or population health management, care management, and/or clinical operations
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace.
