Provider Engagement Executive

About the role

Become a part of our caring community

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, and other areas.

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

Required 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

Additional Information

• 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

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.

• In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs.
• Humana reserves the right to require associates to upgrade their internet service if necessary.
• 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.

$86,300 - $118,700 per year

This 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.