Provider Engagement Executive

Humana • WV

105d • $86,300 - $118,700

About The Position

The Provider Engagement Executive develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve financial and quality performance within the contracted working relationship with the health plan. The Provider Engagement Executive works on problems of diverse scope and complexity ranging from moderate to substantial. The Provider Engagement Executive represents the scope of health plan/provider relationship across such areas as financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, operational improvements and other areas as they relate to provider performance, member experience, market growth, provider experience and operational excellence. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.

Requirements

• Must reside in Virginia.
• Bachelor's Degree.
• 5 or more years of healthcare or managed care experience with Provider Contracting, Network Management, or Provider Relations.
• 2 or more years of project management experience.
• Proven planning, preparation, and presentation skills.
• Comprehensive knowledge of Microsoft Office applications.
• Exceptional relationship management skills.
• Excellent written and verbal communication skills.
• Proficiency in analyzing financial trends for healthcare costs and quality performance.
• Proficiency in quality improvement principles and analyzing quality metrics.
• Comprehensive knowledge of Medicaid policies and managed care contracts.

Nice To Haves

• Master's Degree.
• Clinical Degree (e.g., RN, APRN, PA).
• Experience with the Virginia Medicaid contract.
• Experience with value-based contracting.
• Diverse clinical experience, including working with behavioral health providers, OB/GYNs, and pediatricians.

Responsibilities

• Develop and grow relationships with physicians, providers, and healthcare systems.
• Support and improve financial and quality performance within contracted relationships.
• Represent health plan/provider relationships across various performance areas.
• Advise executives on functional strategies related to provider engagement.
• Exercise independent judgment on complex issues.
• Analyze variable factors to determine the best course of action.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees