Provider Engagement Executive

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

📋 Description

• Cultivate and enhance positive, long-lasting relationships with physicians, providers, and healthcare systems.

• Enhance financial and quality outcomes within established health plan partnerships.

• Serve as the representative for the health plan/provider relationship, focusing on financial performance, incentive initiatives, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, operational enhancements, provider performance, member experience, market expansion, provider satisfaction, and operational excellence.

• Counsel executives and formulate functional strategies, often tailored to specific segments, on critical matters.

• Utilize independent judgment and decision-making capabilities on complex issues.

• Assess variable factors and identify the most effective course of action.

• Occasionally travel to Humana offices for training or meetings.

⛳️ Requirements

• A minimum of 5 years of experience in healthcare or managed care, specifically in Provider Contracting, Network Management, or Provider Relations.

• At least 2 years of proven project management experience.

• Experience collaborating with leadership on strategic initiatives.

• Demonstrated skills in planning, preparation, and presentation.

• Solid understanding of reimbursement and bonus methodologies.

• Over 2 years of experience with Stars/HEDIS measures.

• Must reside in the State of Louisiana.

• Willingness to travel as required (up to 25%).

• A Bachelor's Degree is preferred.

• Ability to analyze and interpret financial trends related to healthcare costs, administrative expenses, and quality/bonus performance.

• Extensive knowledge of Medicare policies, processes, and procedures.

• Proficient in MS Excel, including vLookups and pivot tables.

• Minimum download speed of 25 Mbps and upload speed of 10 Mbps is required.

• Capable of working from a dedicated space without ongoing interruptions to safeguard member PHI/HIPAA information.

🏝️ Benefits

• Bonus incentive plan based on both 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.

• Personal wellness support.

• Healthcare decision support.