[Remote] Provider Engagement Executive at Humana

Tennessee, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Managed CareIndustries

Requirements

2 or more years of Health care or managed care experience with Provider Relations, Provider Contracting, or Network Management
Minimum of 1 year of experience working with provider groups on HEDIS and/or Stars performance improvement
Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance
Experience partnering with senior leadership on strategic initiatives
Established knowledge of reimbursement and bonus methodologies
Proven planning, preparation and presenting skills
Demonstrated ability to manage multiple projects and meet deadlines
Comprehensive knowledge of all Microsoft Office applications
Must be located within the State of Tennessee with the ability to travel as necessary

Responsibilities

Develops and grows positive, long-term relationships with physicians, providers and healthcare systems
Supports and improves financial and quality performance within the contracted working relationship with the health plan
Works on problems of diverse scope and complexity ranging from moderate to substantial
Represents the scope of health plan/provider relationship across areas such as financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, operational improvements and other areas related to provider performance, member experience, market growth, provider experience and operational excellence
Advises executives to develop functional strategies (often segment specific) on matters of significance
Exercises independent judgment and decision making on complex issues regarding job duties and related tasks
Works under minimal supervision, using independent judgment requiring analysis of variable factors and determining the best course of action

Skills

Provider Relations

Provider Contracting

Network Management

HEDIS

Stars Performance

Financial Analysis

Healthcare Costs

Quality Performance

Reimbursement Methodologies

Bonus Methodologies

Strategic Initiatives

Project Management

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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