Associate Director – Provider Engagement

🔥 12 hours ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $115.2k - $158.4k / year

⏰ Full Time

🟠 Senior

👔 Director

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Oversee a team of provider engagement associates • Establish policies and operating procedures for provider engagement representatives • Guide engagement strategy supporting high performance in adult and child quality measures and value-based payment arrangements • Drive closure of care gaps and participation in quality improvement and compliance initiatives • Develop and execute provider outreach campaigns related to quality metrics, quality improvement, and value-based payment models • Partner with the market Quality team and other internal partners • Monitor provider feedback and inform improvements to Humana processes • Monitor team performance against key performance indicators and contractual commitments and requirements • Work with health plan leadership to improve performance as needed • Represent local market leadership in planning and strategy with internal corporate partners • Ensure cross-department alignment and communication • Increase the proportion of the provider network in value-based payment arrangements • Maintain positive provider relationships and contribute to provider retention in Humana's Medicaid networks • Onboard and train new provider engagement team members • Report to the plan's Director, Provider Services

🎯 Requirements

• Must reside in the state of Illinois • Bachelor's degree • Experience with the Illinois Medicaid MCO contract, including value-based payment and quality improvement standards • 6 or more years of progressive experience in managed care operations, including value-based payment, provider performance improvement, and quality • Proficiency in analyzing and interpreting financial trends for healthcare costs, administrative expenses, and quality/bonus performance • Proficiency in quality improvement principles and analyzing quality metrics, such as HEDIS • Prior experience working in and strong understanding of Medicaid and key Medicaid provider types, including pediatrics, OB/GYN, and behavioral health • Exceptional relationship management skills • Two or more years of demonstrated leadership and management experience • Experience partnering with senior leadership on strategic initiatives • Comprehensive knowledge of Medicaid policies, processes, and procedures • Thorough understanding of managed care contracts, including contract language and reimbursement • Diverse clinical experience, including working with LTSS and behavioral health providers, OB/GYNs, and pediatricians • Ability to travel as needed throughout Illinois • Valid state driver's license • Personal vehicle liability insurance meeting applicable minimum limits • Home internet with minimum download speed of 25 Mbps and upload speed of 10 Mbps • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical, dental, and vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Self-provided work-from-home internet service • Remote work arrangement • Occasional travel to Humana offices for training or meetings