Provider Engagement - Physical Health

Oklahoma, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Managed Care, InsuranceIndustries

Requirements

Must reside in Oklahoma and have at least 1 year of experience in healthcare or managed care with provider contracting, network management, or provider relations. Proven planning, preparation, and presentation skills with knowledge of reimbursement and bonus methodologies are required, along with demonstrated ability to manage multiple projects and meet deadlines. A Bachelor's degree and proficiency in analyzing financial trends for healthcare costs, administrative expenses, and quality/bonus performance are preferred.

Responsibilities

Develop and grow positive, long-term relationships with physicians, providers, and healthcare systems to improve financial and quality performance. Represent the health plan's provider relationship scope across 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.

Skills

Provider Contracting

Network Management

Provider Relations

Reimbursement Methodologies

Bonus Methodologies

Project Management

Medicaid Policies

Financial Analysis

Data Analysis

HEDIS

STARs Performance

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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