Remote Provider Relations & Quality Executive

Humana Inc; Virginia; Hybrid; USD 86,000 - 119,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401(k)

Paid time off

Remote-friendly

Job summary

Humana Inc. seeks a Provider Engagement Executive in Virginia to strengthen health-plan/provider relationships, improve quality and value-based care, and lead performance initiatives across HEDIS/STARs and population health.

You will analyze provider performance data, coordinate with cross-functional teams, deliver presentations, and drive strategic programs while ensuring compliance with state requirements. This role is remote with occasional in-state travel.

Qualifications

• 8+ years in health care or managed care with Provider Engagement, Value-Based programs, Provider Relations, or Quality/HEDIS.
• 2+ years of project management experience and managing multiple programs.
• Experience in planning, preparing, and delivering presentations.
• Proficiency in analyzing financial trends for health care costs and quality/bonus performance.
• Comprehensive knowledge of all Microsoft Office applications (Outlook, Excel, PowerPoint, Word).
• Must live in Virginia.
• Travel up to 25% within the state of Virginia.

Responsibilities

• Develop and maintain positive relationships with providers to optimize provider experience and satisfaction.
• Work with internal partners to coordinate quality and VBP data with providers.
• Collaborate with providers to identify population health needs for tailored interventions.
• Gather and analyze reports on provider performance against HEDIS measures and other metrics.
• Implement strategies for improving performance of providers and quality improvement best practices.
• Convene Joint Operating Committee (JOC) and other provider meetings.
• Ensure compliance with Virginia Managed Care Contractual requirements for quality and VBP.
• Monitor feedback from providers to inform Humana process improvements.
• Manage provider continuum and pursue value-based opportunities.
• Facilitate clinical education and intervention regarding utilization.

Skills

Healthcare experience

Project management

Presentation skills

MS Office

Virginia resident

Education

Bachelor's degree

Tools

MS Office

Job description

Humana Inc. seeks a Provider Engagement Executive in Virginia to strengthen health-plan/provider relationships, improve quality and value-based care, and lead performance initiatives across HEDIS/STARs and population health.

You will analyze provider performance data, coordinate with cross-functional teams, deliver presentations, and drive strategic programs while ensuring compliance with state requirements. This role is remote with occasional in-state travel.