Director of Provider Engagement

This is a fully remote position, open to applicants in North Carolina, +2 more states.

📋 Description

• Lead a team of Provider Engagement associates responsible for managing relationships with contracted physicians, provider groups, health systems, and ancillary providers.

• Cultivate and enhance positive, long-term relationships with providers throughout Humana's Medicare Advantage network.

• Implement provider engagement strategies aimed at improving provider experience, quality outcomes, Star Ratings performance, value-based care adoption, risk adjustment performance, and operational excellence.

• Report directly to the VP of Network Performance.

• Act as a prominent market leader by representing Provider Engagement in cross-functional initiatives.

• Ensure that provider needs align with Humana's strategic objectives.

• Develop team strategy, establish operating processes, and set performance expectations.

• Conduct performance evaluations and offer coaching, mentoring, and professional development opportunities.

• Promote accountability, collaboration, continuous improvement, and provider-centric engagement.

• Monitor performance metrics against KPIs and organizational objectives.

• Build and maintain relationships with value-based provider partners.

• Represent Humana at provider meetings, association events, market forums, and strategic discussions with providers.

• Formulate and implement strategies aimed at improving Medicare Star Ratings and achieving quality objectives.

• Collaborate with provider organizations on value-based payment arrangements and alternative payment models.

• Analyze claims, quality, risk adjustment, utilization, and provider performance data to uncover trends, barriers, and opportunities.

• Provide leadership insights regarding provider trends, risks, barriers, and market performance opportunities.

• Track and report on provider engagement activities, strategic initiatives, and performance outcomes.

• Occasionally travel to Humana offices for training or meetings.

⛳️ Requirements

• Minimum of 7 years of experience in managed care, provider relations, healthcare operations, quality improvement, value-based care, or similar healthcare leadership roles.

• At least 5 years of experience in people leadership, including team management and talent development.

• Proven experience working with provider groups, health systems, and healthcare organizations.

• Familiarity with Medicare Advantage operations, provider performance management, and healthcare delivery systems.

• In-depth knowledge of CMS Star Ratings, HEDIS, CAHPS, and risk adjustment methodologies.

• Proficiency in utilizing data and analytics to identify performance improvement opportunities and influence operational outcomes.

• Experience in presenting information to leadership teams.

• Proficiency with Excel and PowerPoint applications.

• Willingness to travel 25% within the assigned market geography.

• Preferred degree in Healthcare Administration, Business Administration, Public Health, or a related field.

• Preferred knowledge of Medicaid regulatory requirements.

• Demonstrated ability in strategic planning and project execution.

• Capability to work from a dedicated space free from ongoing interruptions to safeguard member PHI/HIPAA information.

• Self-provided internet service with a minimum download speed of 25 Mbps and an upload speed of 10 Mbps.

🏝️ 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.

• Home or Hybrid Home/Office work arrangement.

• Professional development opportunities.

• Dedicated home workspace to ensure the protection of member PHI/HIPAA information.

• Internet service requirements/support for home or hybrid employees.