Provider Engagement Executive

Humana

3d • 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

• Bachelor's Degree
• 2 or more years of Health care or managed care with Provider Contracting, Provider Performance, Network Management or Provider Relations experience
• 2 or more years of demonstrated project management or provider performance management experience
• Experience partnering with senior leadership on strategic initiatives
• Established knowledge of reimbursement and bonus methodologies
• Demonstrated ability to manage multiple projects and meet deadlines
• Comprehensive knowledge of all Microsoft Office applications
• Must currently live within the region (PA, MD, DE, NJ)
• Ability to travel up to 15% of the time
• Must have the ability to provide a high speed DSL or cable modem for a home office.
• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Nice To Haves

• Master's Degree
• Knowledge of practice management
• Understanding of MRA, STARS/Hedis measures
• Familiarity with electronic data connectivity
• 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

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, volunteer time off, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

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