Provider Engagement Executive - SC

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.

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
Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of 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.


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 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

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