Provider Engagement Executive

Humana • Work at Home - Virginia, VA

2d • $86,300 - $118,700 • Remote

About The Position

Humana Healthy Horizons in Virginia is seeking a Provider Engagement Executive to join their team. This role represents the scope of health plan/provider relationships across various areas including 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. The Provider Engagement Executive will develop and maintain positive relationships with providers to optimize their experience and satisfaction related to quality improvement and value-based payment performance. They will work with internal corporate partners to ensure cross-department communication and coordination of quality and VBP data with providers, and collaborate with providers to identify population and individual health needs they can address through tailored interventions. The role involves gathering and analyzing reports on provider performance against HEDIS measures, enrollee feedback, utilization patterns, clinical trend measures, and other performance metrics. It also includes implementing strategies for improving provider performance and quality improvement best practices, convening Joint Operating Committee (JOC) and other provider meetings, and ensuring compliance with the state's Managed Care Contractual requirements for supporting providers in quality improvement and value-based payment arrangements. The executive will monitor feedback from individual providers to inform improvements to Humana processes, manage the provider continuum, prospect other providers for value-based opportunities, and facilitate clinical education and intervention regarding utilization.

Requirements

• 8+ years of experience in health care or managed care with Provider Engagement, Value-Based programs, Provider Relations, or Quality/HEDIS
• 2+ years of demonstrated project management experience and managing multiple programs
• Experience planning, preparing, and delivering presentations
• Proficiency in analyzing financial trends for health care costs, administrative expenses and quality/bonus performance
• Comprehensive knowledge of all Microsoft Office applications (Outlook, Excel, Word, PowerPoint)
• Must live in Virginia
• Travel up to 25% within the state of Virginia

Nice To Haves

• Bachelor's degree
• Comprehensive knowledge of Medicaid/Medicare policies, processes and procedures

Responsibilities

• Develops and maintains positive relationships with providers to optimize provider experience and satisfaction related to quality improvement and value-based payment performance
• Works with internal corporate partners to ensure cross-department communication and coordination of quality and VBP data with providers
• Collaborates with providers to identify population and individual health needs they can address through tailored interventions
• Gathers and analyzes reports on provider performance against HEDIS measures, enrollee feedback, utilization patterns, clinical trend measures and other performance metrics
• Implements strategies for improving performance of providers and quality improvement best practice
• Convenes Joint Operating Committee (JOC) and other provider meetings reflecting entire provider support organization
• Ensures compliance with the state's Managed Care Contractual requirements for supporting providers in quality improvement and value-based payment arrangements
• Monitors all feedback from individual providers to inform improvements to Humana processes
• Manages provider continuum, prospecting other providers for value-based opportunities
• Facilitates clinical education and intervention regarding utilization

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