Provider Engagement Executive - Behavioral Health

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Job Information
Humana
Provider Engagement Executive - Behavioral Health
in
Cincinnati
Ohio
Description
The Behavioral Health Provider Engagement Executive utilizes their knowledge and skills to develop and grow 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 Behavioral Health Provider Engagement Executive works on problems that are inclusive of mental health and substance abuse services; and are of diverse scope and complexity ranging from moderate to substantial.
Responsibilities
The Behavioral Health 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. The Behavioral Health Provider Engagement Executive works with key behavioral health providers in the state including high profile hospital and healthcare systems. Experience with relationship building, management and strategic planning with executive level leaders at these organizations is required. Once COVID-19 restrictions have been lifted, regional travel will be an expected part of this role.
Required Qualifications
Bachelor's Degree in a behavioral-health field or equivalent work experience
8 or more years of health care or managed care with Provider Contracting, Network Management or Provider Relations experience
2 or more years of demonstrated project management experience and partnering with senior leadership on strategic initiatives
Comprehensive knowledge of The Ohio Department of Medicaid program with a special focus on Behavioral Health Redesign and OhioRISE
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
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits
WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.
Must reside in OHIO
Preferred Qualifications
Master's degree in a behavioral-health field, such as social work, psychology, or related health discipline
Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance
Comprehensive knowledge of Medicare processes, policies and procedures
Additional Information
Must reside in Ohio
Up to 15% Travel within the State of Ohio
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.
#LI-KR1
Scheduled Weekly Hours
40

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