Associate Director, Provider Engagement

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Lead a team of associates dedicated to fostering positive, lasting relationships with contracted providers.

• Promote high-quality, valuable care for Humana members.

• Act as a subject matter expert in value-based contracting, performance enhancement, HEDIS, and quality improvement.

• Represent Humana Healthy Horizons in Illinois in dealings with providers.

• Develop and implement policies and operational procedures for Provider Engagement Associates.

• Create and execute outreach campaigns for providers focused on quality metrics, quality enhancement, and value-based payment models.

• Collaborate with the market Quality team and other internal stakeholders.

• Assess provider feedback to inform enhancements to Humana processes.

• Track team performance against key performance indicators and contractual obligations.

• Collaborate with health plan leadership to enhance performance.

• Represent local market leadership in planning and strategic initiatives with internal corporate partners.

• Increase the share of the provider network engaged in value-based payment arrangements.

• Maintain strong provider relationships and aid in provider retention within Humana's Medicaid networks.

• Onboard and train new members of the provider engagement team.

• Report directly to the plan's Director of Provider Services.

⛳️ Requirements

• Must be a resident of the state of Illinois.

• Bachelor's degree required.

• Familiarity with the Illinois Medicaid MCO contract, including value-based payment and quality improvement standards.

• At least 6 years of progressive experience in managed care operations, covering value-based payment, provider performance enhancement, and quality.

• Skilled in analyzing and interpreting financial trends related to healthcare costs, administrative expenses, and quality/bonus performance.

• Proficient in quality improvement concepts and analyzing quality metrics, including HEDIS.

• Previous experience and strong understanding of Medicaid and key provider types, such as pediatrics, OB/GYN, and behavioral health.

• Outstanding relationship management capabilities.

• Over two years of proven leadership and management experience, collaborating with senior leadership on strategic projects.

• In-depth knowledge of Medicaid policies, processes, and procedures, including managed care contracts, contract language, and reimbursement structures.

• Diverse clinical experience, including working with LTSS and behavioral health providers, OB/GYNs, and pediatricians to enhance performance and quality.

• Willingness to travel as needed across Illinois.

• Valid state driver's license required.

• Personal vehicle liability insurance that meets applicable minimum requirements or stated coverage limits.

• Master's degree is preferred.

• Clinical degree (e.g., RN, APRN, PA) and/or experience in healthcare administration or quality improvement is preferred.

• Experience in building teams from the ground up in a fast-paced implementation setting is preferred.

• Home work area must be dedicated and free from ongoing interruptions to protect member PHI/HIPAA information.

🏝️ Benefits

• Bonus incentive plan based on company and/or individual performance.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Self-provided internet service for home or hybrid home/office work, meeting minimum speeds of 25 Mbps download and 10 Mbps upload.

• Remote work with occasional travel to Humana offices for training or meetings.