Provider Engagement Executive

Humana; Richmond (VA); Remote; USD 86,000 - 119,000; Full time

Benefits offered by this job

Bonus incentive plan

Medical benefits

401(k) plan

Paid time off

Job summary

Humana is seeking a Provider Engagement Executive to strengthen health plan/provider relationships across financial performance, quality, and population health initiatives. You will report to the Director, Provider Engagement and collaborate with cross-functional teams in Virginia.

Responsibilities include developing provider partnerships, analyzing HEDIS/STARs data, coordinating with internal stakeholders, and advancing value-based care strategies.

Qualifications

• 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

Responsibilities

• Develops and maintains positive relationships with providers to optimize provider experience and satisfaction related to quality improvement and value-based payment performance
• Works with internal corporate partners to ensure cross-department communication and coordination of quality and VBP data with providers
• Collaborates with providers to identify population and individual health needs they can address through tailored interventions
• Gathers and analyzes reports on provider performance against HEDIS measures, enrollee feedback, utilization patterns, clinical trend measures and other performance metrics
• Implements strategies for improving performance of providers and quality improvement best practice
• Convenes Joint Operating Committee (JOC) and other provider meetings reflecting entire provider support organization
• Ensures compliance with the state's Managed Care Contractual requirements for supporting providers in quality improvement and value-based payment arrangements
• Monitors all feedback from individual providers to inform improvements to Humana processes
• Manages provider continuum, prospecting other providers for value-based opportunities
• Facilitates clinical education and intervention regarding utilization

Skills

Provider Engagement

Value-Based Programs

Provider Relations

Quality/HEDIS

Data Analysis

Education

Bachelor's degree

Tools

Microsoft Office

Job description

Become a part of our caring community

Humana Healthy Horizons in Virginia is seeking a Provider Engagement Executive to join our team. The Provider Engagement Executive represents the scope of health plan/provider relationships across various areas including 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. You will report to the Director, Provider Engagement.

Responsibilities

• Develops and maintains positive relationships with providers to optimize provider experience and satisfaction related to quality improvement and value-based payment performance
• Works with internal corporate partners to ensure cross-department communication and coordination of quality and VBP data with providers
• Collaborates with providers to identify population and individual health needs they can address through tailored interventions
• Gathers and analyzes reports on provider performance against HEDIS measures, enrollee feedback, utilization patterns, clinical trend measures and other performance metrics
• Implements strategies for improving performance of providers and quality improvement best practice
• Convenes Joint Operating Committee (JOC) and other provider meetings reflecting entire provider support organization
• Ensures compliance with the state's Managed Care Contractual requirements for supporting providers in quality improvement and value-based payment arrangements
• Monitors all feedback from individual providers to inform improvements to Humana processes
• Manages provider continuum, prospecting other providers for value-based opportunities
• Facilitates clinical education and intervention regarding utilization

Use your skills to make an impact

Required Qualifications

• 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

Preferred Qualifications

• Bachelor's degree
• Comprehensive knowledge of Medicaid/Medicare policies, processes and procedures

Additional Information

Workstyle

Remote. Will use Humana office space on an as needed basis for collaboration and other face-to-face needs

Work Location

Must reside in Virginia

Work Hours

Monday – Friday, 8:00 am – 5:00 pm (EST)

Travel

Up to 25% travel throughout Virginia

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.

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

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 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.