Provider Engagement Executive

Profile

Description

The Provider Engagement Executive 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 Provider Engagement Executive works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

The Provider Engagement Executive 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. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.

Required Qualifications

Bachelor's Degree

5 or more years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience

2 or more years of demonstrated project management experience and partnering with senior leadership on strategic initiatives

Must be familiar with CMS quality metrics (HEDIS, Stars, etc.)

Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies

Demonstrated ability to manage multiple projects and meet deadlines

Strong presentation and communication skills with ability to effectively partner with senior level executives

Comprehensive knowledge of all Microsoft Office applications

Ability to travel as needed, primarily within the State of Pennsylvania, with some overnight travel required

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

Master's Degree

Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance

Experience working with value-based care

Comprehensive knowledge of Medicare policies, processes and procedures

Additional Information

This is a remote/work at home position, however, you must live within the State of Pennsylvania, with preference given to candidates who are located in the central part of the State.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com