Provider Engagement Lead: Value-Based Care & Partnerships

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

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.