Senior Provider Engagement Professional-1-1

Humana Inc; Ohio; Remote; USD 71,000 - 98,000; Full time

Job summary

Join a leading healthcare company as a Senior Provider Engagement Professional. You will develop relationships with healthcare providers, manage complex issues, and influence departmental strategies. This role requires strong analytical skills and a passion for improving healthcare experiences. Enjoy a comprehensive benefits package and the opportunity to make a significant impact in the Medicaid team.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

401(k)

Paid Time Off

Disability Insurance

Life Insurance

Qualifications

• 5 years of experience in healthcare or managed care.
• Knowledge of reimbursement and bonus methodologies.

Responsibilities

• Manage relationships across financial performance and quality.
• Collaborate with providers to enhance performance.

Skills

Planning

Presentation

Analytical Skills

Education

Bachelor's Degree

Master'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 part of our Medicaid team. The Senior Provider Engagement Professional develops and maintains positive, long-term relationships with physicians, providers, and healthcare systems to support and improve financial and quality performance within the contracted relationship with the health plan. The role involves addressing moderately complex to complex issues requiring in-depth analysis of situations or data. The Senior Provider Engagement Professional will collaborate with key providers across the state, including Primary Care Providers (PCPs), FQHCs/RHCs, and Hospital Systems.

Key Responsibilities

• Manage relationships across areas such 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 provider-related areas.
• Influence departmental strategy and make decisions on complex issues regarding technical approaches for project components, often working independently with considerable latitude.
• Collaborate with providers to enhance performance and operational efficiency.

Use your skills to make an impact

Required Qualifications

• Bachelor's Degree
• At least 5 years of experience in healthcare or managed care, specifically in Provider Contracting, Network Management, or Provider Relations
• Strong planning, preparation, and presentation skills, with knowledge of reimbursement and bonus methodologies
• Ability to manage multiple projects and meet deadlines
• Passion for improving consumer experiences

Preferred Qualifications

• Master's Degree
• Proficiency in analyzing financial trends related to healthcare costs, expenses, and performance metrics
• Knowledge of Medicare policies and procedures

Additional Information

We utilize HireVue interviewing technology to streamline our hiring process. Internet requirements for remote work include a minimum download speed of 25 Mbps and upload speed of 10 Mbps, with specific guidelines for satellite, cellular, or microwave connections. Employees working from home in certain states will receive internet expense reimbursement. A dedicated workspace free from interruptions is required to protect member PHI/HIPAA information. Occasional travel to Humana offices may be necessary.

Scheduled Weekly Hours: 40

Pay Range: $71,100 - $97,800 annually, commensurate with experience and location. This position is eligible for a bonus plan based on performance.

Benefits

Humana offers comprehensive benefits including medical, dental, vision, 401(k), paid time off, disability insurance, life insurance, and more to support your well-being and work-life balance.

About Us

Humana Inc. is dedicated to putting health first for our members, employees, and communities, providing accessible healthcare services to improve quality of life for diverse populations.

Equal Opportunity Employer

Humana is committed to a diverse and inclusive workforce, ensuring employment decisions are based on valid job requirements and free from discrimination based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, disability, or veteran status.