Provider Engagement Executive

Humana Inc; Louisiana (MO); Hybrid; USD 86,000 - 119,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k)

Job summary

Humana Inc. seeks a Provider Engagement Executive to develop and grow strategic relationships with physicians, providers and health systems under contracted arrangements with the health plan.

You will influence financial and quality performance, while working on provider engagement initiatives and STARs/HEDIS measures. This remote role requires Louisiana residency and some travel.

Qualifications

• 5+ years in health care or managed care with provider contracting or related areas.
• 2+ years of project management experience.
• Experience partnering with leadership on strategic initiatives.
• Knowledge of reimbursement and bonus methodologies.
• 2+ years working with Stars/HEDIS measures.

Responsibilities

• Develop and grow long-term relationships with physicians, providers and health systems to improve financial and quality performance under the health plan contract.
• Represent provider performance domains across financial, quality, data sharing and operational areas.
• Advise executives to devise functional strategies; exercise independent judgement on complex issues.
• Travel up to 25% as needed to support partnerships.

Skills

Provider contracting

Network management

Provider relations

Project management

Strategic initiatives

Reimbursement knowledge

Stars/HEDIS measures

Travel readiness

Education

Bachelor's Degree

Tools

MS Excel

Pivot tables

VLOOKUPs

Job description

Become a part of our caring community The Provider Engagement Executive develops and grows 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 Provider Engagement Executive works on problems of diverse scope and complexity ranging from moderate to substantial.

The 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.

Use your skills to make an impact

Required Qualifications

• 5 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
• Experience partnering with leadership on strategic initiatives
• Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies
• 2+ years of experience working with Stars/HEDIS measures
• Must live in the State of Louisiana
• Ability to travel as needed (up to 25%)

Preferred Qualifications

• Bachelor's Degree
• Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance
• Comprehensive knowledge of Medicare policies, processes and procedures
• Advanced working knowledge of MS Excel (vLookups, pivot tables)

Additional Information

This role is "remote/work at home", however, you must live within the State of Louisiana to be considered for this opportunity.

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.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$86,300 - $118,700 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 atHumana.comand atCenterWell.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.