Provider Engagement, Clinical Executive

Humana • Milwaukee, WI

10d • Hybrid

About The Position

The Provider Engagement, Clinical Executive develops and grows positive, long-term relationships with physicians, providers, and healthcare systems. We develop these relationships to support financial and quality performance within the contracted working relationship with the health plan. The Provider Engagement, Clinical Executive works on problems of diverse scope and complexity ranging from moderate to substantial. The Provider Engagement, Clinical Executive represents the scope of health plan/provider relationship across several areas. These areas include financial performance, incentive programs, quality and clinical management, population health, and data sharing. They also include connectivity, documentation and coding, HEDIS and STARs performance, operational improvements, and other areas. The job relates these other areas to provider performance, member experience, market growth, provider experience, and operational excellence. This work focuses on areas of clinical emphasis. Advise Market leaders to develop functional strategies on matters of significance. Reporting to the Director, Quality Improvement you will work on complex issues and determine the best course of action.

Requirements

• Registered Nurse OR a Bachelor's degree in Social Work, Public Health or Health Administration
• Must reside in the state of Wisconsin
• Ability to travel up to 10% in the Milwaukee area AND to provider offices throughout the state
• Minimum 3 years developing or implementing clinical strategies, with a focus on provider outcomes
• Experience in provider clinical programs, payer clinical programs, or value-based care organizations
• Direct experience working with leaders of provider organizations
• Basic knowledge of an integrated care delivery system, Federally Qualified Health Center (FQHC), HEDIS, STARS

Nice To Haves

• Experience in clinical practice working with or within a provider organization
• Implement Quality Improvement programs and strategies
• Use healthcare data and analytics to inform program development

Responsibilities

• Support and execute on the market's provider engagement strategy, including VBP, high-volume FFS and dual-eligible memberships
• Determine meeting type (JOC, Clinical/Quality, Operation) and frequency
• Develop or standardize provider meeting presentations and reporting package(s)
• Create provider scorecards
• Create market provider performance profiling and develop strategy to target low performing providers
• Develop strategy for relaying performance data and detail to physicians, providers, and health systems
• Develop adoption strategy for market and Corporate tools and methodologies
• Oversee, plans, and implement provider facing QI programs, including scorecard development/monitoring, gaps in care reports, and CAHPS survey results/strategy including Behavioral Health Measures
• Contribute to development and oversight of care coordination and outcome reporting
• Help develop the quality strategy for all provider facing activities, included participating in integrated care internal workgroups
• Collaborate on development of market value-based provider incentive programs, including PCP, specialist, hospital, and clinic

Benefits

• Health benefits effective day 1
• Paid time off, holidays, volunteer time and jury duty pay
• Recognition pay
• 401(k) retirement savings plan with employer match
• Tuition assistance
• Scholarships for eligible dependents
• Parental and caregiver leave
• Employee charity matching program
• Network Resource Groups (NRGs)
• Career development opportunities
• medical, dental and vision benefits
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Senior