Provider Engagement Executive

Humana • Colorado Springs, CO

8d • $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

• 6 or more years of health care or managed care operations to include provider relations and/or provider contracting
• Experience working with HEDIS and/or Stars measures and programs
• 2 or more years of demonstrated project management experience and partnering with senior leadership on strategic initiatives.
• Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies.
• Demonstrated ability to manage multiple projects and meet deadlines.
• Comprehensive knowledge of Medicare policies, processes and procedures.
• Must reside in either Phoenix, AZ or Denver, CO with the ability to travel as needed, including overnight within the region (CA, NV, AZ, CO, NM)
• Minimum download speed of 25 Mbps and an upload speed of 10 Mbps.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Nice To Haves

• Bachelor's Degree
• Phoenix, AZ location is highly preferred
• Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance.

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 and 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
• many other opportunities

What This Job Offers

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