Senior Provider Engagement Professional - Humana Healthy Horizons Ohio

Employment Type: Full-time

Position Overview

Humana Healthy Horizons Plan in Ohio seeks a highly motivated Senior Provider Engagement Professional to provide end-to-end provider experience as a member of our Medicaid team. This role focuses on developing and growing positive, long-term relationships with physicians, providers, and healthcare systems to support and improve financial and quality performance within the contracted working relationship with the health plan.

The Senior Provider Engagement Professional will work with key providers throughout the state, including Primary Care Providers (PCPs), FQHCs/RHCs, and Hospital Systems. This role represents the scope of the health plan/provider relationship across areas such as provider service experience, value-based programs, behavioral health, and Substance Use Disorder programs. The position supports the department’s strategy and involves making decisions on moderately complex to complex issues regarding the technical approach for project components.

Requirements

• Residency: Must reside in the Central/Southeast Region of Ohio (Columbus and surrounding area).
• Travel: Ability to travel throughout the State of Ohio as needed.
• Education/Experience:
  • Bachelor's Degree and/or 3+ years of managed care experience within provider relations, provider performance, network management, provider service operations, and/or Behavioral Health operations.
• Skills:
  • Proven planning, preparation, and presenting skills.
  • Knowledge of value-based programs and provider reimbursement methodologies.
  • Demonstrated ability to manage multiple projects and meet deadlines.
  • Passion for contributing to an organization focused on continuously improving consumer experiences.

Preferred Qualifications

• Experience with Substance Use Disorder and other behavioral health programs, policy, procedures, and provider payment methodologies.
• Experience in a behavioral health field or equivalent work experience with knowledge of behavioral health policies and procedures related to the treatment and care of patients.
• Knowledge of The Ohio Department of Medicaid Next Generation Program, with a focus on Behavioral Health Redesign and OhioRISE.
• 2 or more years of demonstrated project management experience and partnering with senior leadership on strategic initiatives.
• Proficiency in analyzing and interpreting financial trends for healthcare costs, administrative expenses, and quality/bonus performance.
• Comprehensive knowledge of Medicare policies, processes, and procedures.

Application Instructions

• As part of the hiring process, candidates will participate in an interview using HireVue technology.

Company Information

Become a part of our caring community and help us put health first.

Additional Information

• Internet Requirements for Remote Work:
  • Minimum download speed of 25 Mbps and upload speed of 10 Mbps.
  • Wireless, wired cable, or DSL connection is suggested.
  • Satellite, cellular, and microwave connections may be used only if approved by leadership.
  • Employees in California, Illinois, Montana, or South Dakota will receive a bi-weekly internet expense payment.
• Equipment: Humana will provide appropriate telephone equipment for remote employees.
• Work Environment: Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• Travel: While this is a remote position, travel is required as noted above.