Provider Engagement Executive

🔥 0 minutes ago

⚔️ Virginia – Remote

⚔️ Virginia – Remote

💵 $86.3k - $118.7k / year

⏰ Full Time

🟠 Senior

🔴 Lead

👔 Executive

🦅 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

• Represent health plan/provider relationships across financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, and operational improvements • Develop and maintain positive provider relationships to optimize provider experience and satisfaction related to quality improvement and value-based payment performance • Coordinate quality and value-based payment data with providers and internal corporate partners • Collaborate with providers to identify population and individual health needs for tailored interventions • Gather and analyze provider performance reports, HEDIS measures, enrollee feedback, utilization patterns, clinical trend measures and other performance metrics • Implement strategies to improve provider performance and quality-improvement best practices • Convene Joint Operating Committee and other provider meetings representing the provider support organization • Ensure compliance with state Managed Care Contractual requirements for provider quality improvement and value-based payment arrangements • Monitor provider feedback to inform improvements to Humana processes • Manage the provider continuum and prospect providers for value-based opportunities • Facilitate clinical education and utilization interventions • Report to the Director, Provider Engagement

🎯 Requirements

• 8+ years of experience in health care or managed care with Provider Engagement, Value-Based programs, Provider Relations, or Quality/HEDIS • 2+ years of demonstrated project management experience and managing multiple programs • Experience planning, preparing, and delivering presentations • Proficiency in analyzing financial trends for health care costs, administrative expenses and quality/bonus performance • Comprehensive knowledge of all Microsoft Office applications (Outlook, Excel, Word, PowerPoint) • Must live in Virginia • Travel up to 25% within the state of Virginia • Comprehensive knowledge of Medicaid/Medicare policies, processes and procedures preferred • Bachelor's degree preferred • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan based on 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 • Remote work arrangement • Use of Humana office space on an as-needed basis • Dedicated home workspace and internet requirements supporting remote work