[Hiring] Provider Engagement Executive @Humana

Role Description

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

You will report to the Director, Provider Engagement.

• 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.

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.

Requirements

• 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: Minimum download speed of 25 Mbps and upload speed of 10 Mbps required; wireless, wired cable or DSL connection suggested.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• 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.

• $86,300 - $118,700 per year.
• This job is eligible for a bonus incentive plan based upon company and/or individual performance.

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.

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.