Provider Engagement Executive - GA/SC

Profile

Job Information

Humana

Provider Engagement Executive - GA/SC

in

Lancaster

South Carolina

Description

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.

Responsibilities

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.

Required Qualifications

Bachelor's Degree

5 or more years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience

3 or more years of demonstrated project management experience and consulting with senior leadership and leading cross-functional teams on strategic initiatives

Established knowledge of reimbursement and bonus methodologies as it relates to Value Based contracts

Proven success working with provider groups to positively impact P&L revenue and expenses

Demonstrated ability to manage multiple projects and meet deadlines

Proven planning, preparation and presentation skills

Valid driver's license with reliable transportation and the ability to travel within the State of Georgia, as required

Must be passionate about contributing to an organization focused on continuously improving provider experiences

For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.If progressed to offer, you will be required to:

Provide proof of full vaccination or commit to testing protocols

*OR  *

Provide proof of applicable exemption including any required supporting documentation

​​Medical, religious, state and remote-only work exemptions are available.

Preferred Qualifications

Master's Degree

Experience working with Stars/HEDIS metrics and measures

Experience with value based operations and identifying areas of opportunity within a provider group

Comprehensive knowledge of Medicare Advantage policies, processes and procedures

Additional Information

This position will be hybrid work at home/remote, however, you must live within the State of Georgia or South Carolina, as you will be required to travel to provider groups 40-50% of the time within the region as well as the Humana Office, as necessary.

Work at Home/Remote Requirements

Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

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

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com