Provider Engagement Executive

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

📋 Description

• Act as a liaison for health plan/provider relationships concerning financial outcomes, incentive initiatives, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, as well as operational enhancements.

• Foster and sustain positive relationships with providers to enhance their experience and satisfaction in regard to quality improvement and value-based payment performance.

• Coordinate quality and value-based payment data in collaboration with providers and internal corporate partners.

• Work alongside providers to identify the health needs of populations and individuals for customized interventions.

• Collect and evaluate provider performance reports, HEDIS metrics, enrollee feedback, utilization trends, clinical trend measures, and additional performance indicators.

• Execute strategies aimed at enhancing provider performance and best practices for quality improvement.

• Organize Joint Operating Committee meetings and other provider meetings on behalf of the provider support organization.

• Ensure adherence to state Managed Care Contractual requirements related to provider quality improvement and value-based payment agreements.

• Monitor provider feedback to guide enhancements to Humana processes.

• Oversee the provider continuum and seek new providers for value-based opportunities.

• Facilitate clinical education and utilization interventions.

• Report directly to the Director of Provider Engagement.

⛳️ Requirements

• Over 8 years of experience in healthcare or managed care in areas such as Provider Engagement, Value-Based programs, Provider Relations, or Quality/HEDIS.

• At least 2 years of proven project management experience, with the ability to manage multiple programs simultaneously.

• Experience in planning, preparing, and delivering presentations effectively.

• Strong analytical skills in assessing financial trends related to healthcare costs, administrative expenses, and quality/bonus performance.

• Extensive knowledge of all Microsoft Office applications, including Outlook, Excel, Word, and PowerPoint.

• Residency in Virginia is required.

• Willingness to travel up to 25% within the state of Virginia.

• Preferred knowledge of Medicaid/Medicare policies, processes, and procedures.

• A Bachelor's degree is preferred.

• Home internet speed must meet a minimum of 25 Mbps download and 10 Mbps upload.

• A dedicated workspace free from interruptions is necessary 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.

• Remote work arrangement.

• Access to Humana office space as needed.

• Requirements for a dedicated home workspace and internet to support remote work.