Humana

Provider Engagement Executive

Oklahoma, United States

Not SpecifiedCompensation
Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, Managed CareIndustries

Requirements

Candidates must possess a Bachelor's degree or 6+ years of equivalent experience in managed care, with at least 6 years of experience in healthcare or managed care focusing on 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. Proven planning, preparation, and presenting skills, along with established knowledge of reimbursement and bonus methodologies, are essential. The role demands a comprehensive knowledge of all Microsoft Office applications, the ability to manage multiple projects and meet deadlines, and the capacity to travel as needed within Oklahoma. A Master's degree and proficiency in analyzing financial trends for healthcare costs, administrative expenses, and quality/bonus performance are preferred, as is comprehensive knowledge of Medicare policies, processes, and procedures.

Responsibilities

The Provider Engagement Executive is responsible for developing and growing positive, long-term relationships with physicians, providers, and healthcare systems to support and improve financial and quality performance. This role involves addressing complex problems related to the health plan/provider relationship, including financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, and operational improvements. The executive will advise executives on functional strategies, exercise independent judgment on complex issues, and determine the best course of action with minimal supervision.

Skills

Managed care
Provider Contracting
Network Management
Provider Relations
Project Management
Strategic Initiatives
Reimbursement Methodologies
Bonus Methodologies
Microsoft Office

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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