Humana

Provider Engagement Executive

Ohio, United States

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

Requirements

Candidates must reside in Ohio and possess a Bachelor's degree or equivalent work experience. A minimum of 8 years of experience in healthcare or managed care, with a focus on provider contracting, network management, or provider relations, is required. Additionally, 2 or more years of demonstrated project management experience and experience partnering with senior leadership on strategic initiatives are necessary. Proven planning, preparation, and presenting skills, along with established knowledge of reimbursement and bonus methodologies, are essential. Candidates must demonstrate the ability to manage multiple projects and meet deadlines, possess comprehensive knowledge of all Microsoft Office applications, and have the ability to travel as needed. A valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits are required. High-speed DSL or cable modem internet service with a minimum download speed of 10Mbps and upload speed of 1Mbps is mandatory for home office use. A Master's degree and proficiency in analyzing financial trends for healthcare costs, administrative expenses, and quality/bonus performance, along with comprehensive knowledge of Medicare policies, processes, and procedures, are preferred.

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. They will represent the scope of health plan/provider relationships 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, provider performance, member experience, market growth, provider experience, and operational excellence. This role involves advising executives on functional strategies, exercising independent judgment and decision-making on complex issues, and working with minimal supervision. The executive will work with key providers in Ohio, including high-profile hospital and healthcare systems, and will be expected to travel regionally once COVID-19 restrictions are lifted.

Skills

Provider Contracting
Network Management
Provider Relations
Relationship Building
Management
Strategic Planning
Executive Leadership
Health Plan Operations
Quality Improvement
Financial Performance
HEDIS
STARs

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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