Senior Provider Network Manager
Maven ClinicFull Time
Senior (5 to 8 years)
Candidates must possess a minimum of 5 years of healthcare or managed care experience, including value-based agreements, provider contracting, network management, or provider relations. A minimum of 2 years of demonstrated project management experience and experience partnering with senior leadership on strategic initiatives are required, along with 2 years of experience working with CMS Stars, HEDIS, and patient safety programs. A strong understanding of quality improvement programs and regulatory reporting standards, demonstrated ability to analyze and act on performance metrics, and experience managing and interpreting relevant survey data are essential. Proficiency in analyzing and interpreting financial trends for healthcare costs, administrative expenses, and quality performance, along with proven planning, preparation, and presenting skills, and comprehensive knowledge of Microsoft Office applications are also necessary. A Bachelor's degree and comprehensive knowledge of Medicare policies, processes, and procedures are preferred. Minimum internet download speed of 25 mbps and upload speed of 10 mbps is required for remote work.
The Provider Engagement Executive will develop and grow positive, long-term relationships with physicians, providers, and healthcare systems to support and improve financial and quality performance within the health plan's contracted working relationship. They will own the health plan/provider relationship across various areas including financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and Stars performance, operational improvements, market growth, provider experience, and operational excellence. The role involves working on problems of diverse scope and complexity, ranging from moderate to substantial.
Health insurance provider for seniors and military
Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.