Provider Engagement Executive

Humana • Louisiana, MO

5d • $86,300 - $118,700 • Remote

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

• 5 or more years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience
• 2 or more years of demonstrated project management experience
• Experience partnering with leadership on strategic initiatives
• Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies
• 2+ years of experience working with Stars/HEDIS measures
• Must live in the State of Louisiana
• Ability to travel as needed (up to 25%)
• Minimum download speed of 25 Mbps and an upload speed of 10 Mbps for internet service
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Nice To Haves

• Bachelor's Degree
• Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance
• Comprehensive knowledge of Medicare policies, processes and procedures
• Advanced working knowledge of MS Excel (vLookups, pivot tables)

Responsibilities

• Develops and grows positive, long-term relationships with physicians, providers and healthcare systems.
• Supports and improves financial and quality performance within the contracted working relationship with the health plan.
• Represents the scope of health plan/provider relationship across financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, operational improvements, provider performance, member experience, market growth, provider experience and operational excellence.
• Advises executives to develop functional strategies on matters of significance.
• Exercises independent judgment and decision making on complex issues regarding job duties and related tasks.
• Uses independent judgment requiring analysis of variable factors and determining the best course of action.

Benefits

• medical
• dental
• vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Associate degree