Director of Provider Engagement

Humana Inc; Georgia; Hybrid; USD 139,000 - 191,000; Full time

Benefits offered by this job

Bonus incentive plan

Travel opportunities

Job summary

Humana Inc in the United States seeks a Director, Provider Engagement to lead a team of Provider Engagement associates responsible for developing and strengthening relationships with contracted physicians, provider groups, and health systems across Humana's Medicare Advantage network.

You will drive engagement strategies to improve provider experience, quality outcomes, and Star Ratings, while enabling value-based care adoption and performance reporting.

Qualifications

• 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

Responsibilities

• Lead, develop, and support a team of Provider Engagement associates responsible for managing relationships with contracted providers and healthcare organizations.
• Develop and execute provider engagement strategies that support Medicare Star Ratings improvement and quality performance objectives.

Skills

Leadership

Data analytics

Provider relations

Strategic planning

Presentation to leadership

Excel

PowerPoint

Travel 25%

Education

Degree in Healthcare Administration, Business Administration, Public Health, or related field

Tools

Excel

PowerPoint

Job description

Become a part of our caring community

The Director, Provider Engagement leads a team of Provider Engagement associates responsible for developing and strengthening positive, long-term relationships with contracted physicians, provider groups, health systems, and ancillary providers across Humana's Medicare Advantage network. You drive provider engagement strategies focused on improving provider experience, quality outcomes, Star Ratings performance, value-based care adoption, risk adjustment performance, and operational excellence. You will report to the VP, Network Performance. You will serve as a key market leader, representing Provider Engagement across cross-functional initiatives and ensuring alignment between provider needs and Humana's strategic priorities.

Lead, develop, and support a team of up to 13 Provider Engagement associates responsible for managing relationships with contracted providers and healthcare organizations. Establish team strategy, operating processes, and performance expectations aligned with organizational objectives. Conduct regular performance evaluations and provide coaching, mentoring, and professional development opportunities. Foster a culture of accountability, collaboration, continuous improvement, and provider-centric engagement. Monitor performance against established key performance indicators and organizational goals. Build and sustain strong relationships with value-based provider partners. Represent Humana at key provider meetings, association events, market forums, and strategic provider discussions. Develop and execute provider engagement strategies that support Medicare Star Ratings improvement and quality performance objectives. Partner with provider organizations to drive performance within value-based payment arrangements and alternative payment models. Utilize claims, quality, risk adjustment, utilization, and provider performance data to identify trends, barriers, and opportunities for improvement. Provide leadership visibility into provider trends, emerging risks, barriers, and opportunities impacting market performance. Ensure accurate tracking and reporting of provider engagement activities, strategic initiatives, and performance results. Use your skills to make an impact.

Required Qualifications

• 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

Preferred Qualifications

• Degree in Healthcare Administration, Business Administration, Public Health, or related field


• Knowledge of Medicaid regulatory requirements


• Demonstrated strategic planning and project execution capabilities

Additional Information

Requires travel up to 25%.

Work at Home Requirements

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Travel

Ability to travel 25% within assigned market geography.

Scheduled Weekly Hours 40

40

Pay Range

• $138,900 - $191,000 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, \"Humana\") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.