Humana

Provider Engagement Executive

North Carolina, United States

Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, Managed CareIndustries

Requirements

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.

Responsibilities

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.

Skills

Provider Relations
Network Management
Value-Based Agreements
Provider Contracting
Project Management
CMS Stars
HEDIS
Patient Safety Programs
Quality Improvement Programs
Regulatory Reporting
Performance Metrics Analysis
Survey Data Analysis

Humana

Health insurance provider for seniors and military

About Humana

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.

Louisville, KentuckyHeadquarters
1961Year Founded
IPOCompany Stage
Social Impact, HealthcareIndustries
10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.
Rising medical costs and tightening Medicare reimbursements may strain financial performance.
Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.
The company emphasizes inclusivity, offering free language interpreter services for accessibility.
Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.
The company is the first insurer to cover TMS therapy for adolescent depression.
Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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