Senior Practice Support Specialist, RN - Rio Grande Valley

** Explore opportunities with Well Med,
** 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. Explore rewarding opportunities for physicians, clinical staff and non-patient-facing roles. Join us and discover the meaning behind  
** Caring. Connecting. Growing together.*
* The Sr. Practice Support Specialist (PSS) serves as a clinical liaison between contracted primary care practices and Well Med 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 Well Med 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.

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* Primary Responsibilities:

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* + Care & Value Optimization

+ Manage patient census across assigned practices, focusing on high-risk and high-cost cohorts

+ Monitor and influence key utilization metrics: 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)

+ Produce and share scheduled/ad-hoc reports on key metrics

+ Patient Coordination & Engagement

+ 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

+ Provide education on 'call us first'

+ Assist practices in managing high-cost patients and ensuring follow-up on screenings and lab measures

+ Referral & Specialist Strategy

+ 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)

+ Assist practices in understanding and applying QRA strategies

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.

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* Required Qualifications:

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* + Associates Degree in Nursing

+ Current, unrestricted RN license, specific to the state of employment or ability to obtain compact license within 30 days of hire

+ 4+ years of experience in any combination of provider relations, network management, Medicare Advantage, HEDIS, STAR, CMS reimbursement models, risk adjustment

+ Solid analytics, communication, relationship-building, and proficiency in Microsoft Office

+ Ability to travel extensively (up to 75-85%) and possess a valid drivers license issued by the state of practice

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* Preferred Qualifications:

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* + 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

** Performance Metrics:*
* + Reduction in Admits/K and Readmits/K

+ Increased engagement of high-risk cohorts and care initiatives

+ Timely closure of care gaps and improved documentation accuracy

+ Provider satisfaction and resolution of escalated issues

** Physical & Mental Requirements:*
* + Ability to sit/stand for extended periods; operate office equipment

+ Ability to drive and travel extensively

+ Ability to lift up to 25 lbs

+ Ability to comprehend instructions and apply logical reasoning

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…