Provider Engagement Executive
Humana

Job Info

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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
• Proven planning, preparation and presentation skills
• Established knowledge of reimbursement and bonus methodologies as it relates to Value Based contracts
• Demonstrated ability to manage multiple projects and meet deadlines
• Comprehensive knowledge of all Microsoft Office applications
• Valid driver's license with reliable transportation and the ability to travel within the State of Georgia, as required
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Master's Degree
• Experience working with Stars/HEDIS metrics and measures
• Comprehensive knowledge of Medicare Advantage policies, processes and procedures

Additional Information

This position will be "work at home/remote", however, you must live within the State of Georgia, as you will be required to travel to provider groups within the region as well as the Humana Office, as necessary.

Work at Home/Remote Requirements Must ensure designated work area is free from distractions during work hours and virtual meetings Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required

Scheduled Weekly Hours

40

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