Registered Nurse Provider Support Specialist
RemotePosted 2 months ago Expired
This job has expired
Looking for a job like Registered Nurse Provider Support Specialist in or near San Antonio, TX? Upload your resume and we'll notify you when similar positions become available.
Upload Your ResumeAbout This Role
Serve as a clinical liaison to contracted primary care practices, driving value-based care performance and reducing avoidable utilization through proactive patient outreach, interventions, and improved provider engagement. This role focuses on supporting practices in managing high-risk patients and implementing population health strategies.
Responsibilities
- Manage patient census across assigned practices, focusing on high-risk and high-cost cohorts
- Monitor and influence key utilization metrics such as 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, 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
- Analyze utilization and performance data to identify trends and root causes in partnership with PBM and Medical Director team
- Develop action plans aligned with market goals (quality, cost, coding)
- Produce and share scheduled/ad-hoc reports on key metrics
- 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
Requirements
- Associates Degree in Nursing
- Current, unrestricted RN license specific to the state of employment or compact license within 30 days of hire
- 4+ years in provider relations or network management
- Experience with Medicare Advantage, HEDIS, STAR, CMS reimbursement models, risk adjustment
- Solid analytics, communication, relationship-building skills
- Proficiency in Microsoft Office
- Ability to travel extensively (up to 75-85%)
- Valid driver's license issued by the state of practice
Qualifications
- Associates Degree in Nursing
- 4+ years in any combination of provider relations, network management
Nice to Have
- Bachelor's degree in Business or Healthcare Administration
- CPC Certification
- Experience in value-based care or population health management, care management, and/or clinical operations
Skills
* Required skills
Benefits
About Optum
Kelsey-Seybold Clinic, part of the Optum family of businesses, is one of the nation's leading health care organizations, providing coordinated and accountable care across 40+ locations in Houston.