Provider Engagement Executive - Nashville TN

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Job Information

Humana

Provider Engagement Executive - Nashville, TN

in

Nashville

Tennessee

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

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

Experience and understanding of Managed Care

Strategic thinking and planning capabilities; organized and detail-oriented

Excellent written and verbal communication skills

Excellent relationship building skills with both internal and external partners

Willingness to manage and prioritize diverse projects

Business and financial acumen in the health care field

Reliable transportation with the ability to travel within the Nashville Market

Preferred Qualifications

Bachelor's Degree

Understanding of HEDIS/Stars measures and metrics

Understanding of Medicare Risk Adjustment

2 years of demonstrated project management experience and partnering with senior leadership on strategic initiatives

Understanding of managed care reimbursement methodologies

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

Additional Information

This role is remote/work at home, however you must live within the Nashville Metro region, in order to be considered for this position as travel may be be required to external provider locations and into the Nashville office, on occasion for meetings, training, etc.

Work at Home/Remote Requirements Must ensure designated work area is free from distractions during work hours and virtual meetings Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required

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.

Scheduled Weekly Hours

40

Company info

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