Location
Knoxville, TN, United States
Posted on
Oct 19, 2022
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.
Humana 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
Provider Engagement Executive must reside in the Knoxville, TN area
5 years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience
Proven experience working with downside risk agreements
2 years of demonstrated project management experience and partnering with senior leadership on strategic initiatives
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
Business and financial acumen in the health care field
Reliable transportation with the ability to travel within the region up to 30% of the time
Preferred Qualifications
Bachelor's Degree
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 position is considered remote/work at home, however, you must live in the Knoxville, TN area to be considered for this opportunity.
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
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ****
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