Provider Engagement Executive

Profile

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.

In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:

o Medical Benefits

o Dental Benefits

o Vision Benefits

o Health Savings Accounts

o Flex Spending Accounts

o Life Insurance

o 401(k)

o PTO including 7 paid holidays, two personal holidays, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time

o And more

Required Qualifications


Bachelor's Degree
5 years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience
2 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 all Microsoft Office applications
Ability to travel as needed with reliable means of transportation


Preferred Qualifications


Masters Degree
Experience in Value Based Contracts/Programs and driving strategies for high quality/clinical performance with providers
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 will be supporting providers in the New England region, therefore, the selected candidate will live in New England, preferably in Maine, NH, or Massachusetts.


WAH 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


Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of COVID-19 vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Scheduled Weekly Hours

40

Company info

Sign Up Now - ProjectManagementCrossing.com