Director of Provider Engagement

🔥 12 hours ago

🌲 North Carolina, South Carolina, +1 more states – Remote

🌲 North Carolina – Remote 🌴 South Carolina – Remote ⚔️ Virginia – Remote

💵 $138.9k - $191k / year

⏰ Full Time

🔴 Lead

👔 Director

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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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

• Lead a team of Provider Engagement associates responsible for relationships with contracted physicians, provider groups, health systems, and ancillary providers • Develop and strengthen positive, long-term provider relationships across Humana's Medicare Advantage network • Drive provider engagement strategies focused on provider experience, quality outcomes, Star Ratings performance, value-based care adoption, risk adjustment performance, and operational excellence • Report to the VP, Network Performance • Serve as a key market leader representing Provider Engagement across cross-functional initiatives • Ensure alignment between provider needs and Humana's strategic priorities • Establish team strategy, operating processes, and performance expectations • Conduct performance evaluations and provide coaching, mentoring, and professional development • Foster accountability, collaboration, continuous improvement, and provider-centric engagement • Monitor performance against KPIs and organizational goals • Build and sustain relationships with value-based provider partners • Represent Humana at provider meetings, association events, market forums, and strategic provider discussions • Develop and execute strategies supporting Medicare Star Ratings improvement and quality objectives • Partner with provider organizations on value-based payment arrangements and alternative payment models • Use claims, quality, risk adjustment, utilization, and provider performance data to identify trends, barriers, and opportunities • Provide leadership visibility into provider trends, risks, barriers, and opportunities affecting market performance • Track and report provider engagement activities, strategic initiatives, and performance results • Travel occasionally to Humana offices for training or meetings

🎯 Requirements

• 7+ years of experience in managed care, provider relations, healthcare operations, quality improvement, value-based care, or related healthcare leadership roles • 5+ years of people leadership experience, including leading teams and developing talent • Experience working with provider groups, health systems, and healthcare organizations • Knowledge of Medicare Advantage operations, provider performance management, and healthcare delivery systems • Comprehensive knowledge of CMS Star Ratings, HEDIS, CAHPS, and risk adjustment • Experience using data and analytics to identify performance opportunities and influence operational outcomes • Experience presenting to leadership • Experience with Excel and PowerPoint • Ability to travel 25% within assigned market geography • Degree in Healthcare Administration, Business Administration, Public Health, or related field (preferred) • Knowledge of Medicaid regulatory requirements (preferred) • Demonstrated strategic planning and project execution capabilities (preferred) • Ability to work from a dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information • Self-provided internet service with minimum download speed of 25 Mbps and upload speed of 10 Mbps

🏖️ Benefits

• Bonus incentive plan based upon company and/or individual performance • Medical benefits • Dental benefits • 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 • Home or Hybrid Home/Office work arrangement • Professional development opportunities • Dedicated home workspace to protect member PHI/HIPAA information • Internet service requirements/support for home or hybrid employees