Senior Provider Engagement Professional-1-1

Humana; Columbus (OH); Remote; USD 71,000 - 98,000; Full time

Job summary

A leading health care company is seeking a Senior Provider Engagement Professional for its Medicaid team in Ohio. The ideal candidate will have healthcare experience, particularly in provider relations, and be responsible for enhancing the provider experience and financial performance. This role offers competitive compensation, a bonus plan, and comprehensive benefits.

Benefits

Medical, dental, and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Short-term and long-term disability

Life insurance

Qualifications

• 2+ years of healthcare or managed care experience.
• Experience in measure-based gap closure is required.
• Proven ability to manage multiple projects.

Responsibilities

• Develop and maintain relationships with healthcare providers.
• Support quality performance and financial outcomes.
• Influence department strategy and decision-making.

Skills

Planning

Presentation Skills

Quality Improvement

Analytical Skills

Relationship Management

Education

Bachelor's Degree

Job description

Become a part of our caring community and help us put health first
Humana Healthy Horizons Plan in Ohio seeks highly motivated Engagement Professionals to provide end to end provider experience as a member of our Medicaid team. The Senior Provider Engagement Professional 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 Senior Provider Engagement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Provider Engagement Professional will work with key providers throughout the state, including Primary Care Providers (PCPs), FQHCs/RHCs, and Hospital Systems.

The Senior Provider Engagement Professional 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. Begins to influence department strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. The Senior Provider Engagement Professional will work with key providers throughout the state, including Primary Care Providers (PCPs), FQHCs/RHCs, and Hospital Systems.

Use your skills to make an impact

Required Qualifications

• 2 or more years of health care or managed care experience with provider relations, provider contracting, or network management
• Experience in measure-based gap closure (quality improvement, HEDIS, MPS or similar)
• Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies
• Demonstrated ability to manage multiple projects and meet deadlines
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Must live in Northeast or Central/Southeast Ohio (Columbus or Akron, OH)

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 Medicaid policies, processes and procedures

Additional Information

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

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.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
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.$71,100 - $97,800 per yearThis 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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.