Provider Engagement Executive
About the role
The Provider Engagement Executive develops and grows positive, long-term relationships with physicians, providers, and healthcare systems to support and improve financial and quality performance within the contracted working relationship with the health plan. This role works on problems of diverse scope and complexity, representing the health plan/provider relationship 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 areas related 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, working under minimal supervision and using independent judgment requiring analysis of variable factors.
Responsibilities
- Develop and maintain long-term relationships with physicians, providers, and healthcare systems.
- Support and improve financial and quality performance within contracted relationships.
- Address issues related to financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, and operational improvements.
- Advise executives on functional strategies for provider performance, member experience, market growth, and operational excellence.
- Exercise independent judgment on complex issues and determine the best course of action.
- Partner with senior leadership on strategic initiatives.
- Manage multiple projects and meet deadlines.
Requirements
- Minimum of an Associate's Degree.
- 4 or more years of healthcare or managed care experience with Provider Contracting, Network Management, or Provider Relations.
- Experience working with HEDIS and/or Stars measures and programs.
- 1 or more years of demonstrated project management experience.
- Proven planning, preparation, and presenting skills.
- Demonstrated ability to manage multiple projects and meet deadlines.
- Comprehensive knowledge of all Microsoft Office applications.
- Must be located within the State of Indiana with the ability to travel as needed.
Preferred Qualifications
- Bachelor's Degree.
- Established knowledge of reimbursement and bonus methodologies.
- Proficiency in analyzing and interpreting financial trends for healthcare costs, administrative expenses, and quality/bonus performance.
- Comprehensive knowledge of Medicare policies, processes, and procedures.
- Located in Indianapolis, IN.
Pay
The pay range for this role is $86,300 - $118,700 per year. This job is eligible for a bonus incentive plan based on company and/or individual performance.
Schedule
Scheduled Weekly Hours: 40.
This role is remote/work at home, but you must live in the State of Indiana, with the ideal candidate being located in Indianapolis.
Benefits
- Medical, dental, and vision benefits.
- 401(k) retirement savings plan.
- Paid time off, including company and personal holidays, paid parental and caregiver leave.
- Short-term and long-term disability.
- Life insurance.
About Us
Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health.