Provider Support Model Lead, Provider Engagement

About the Role

Employment Type: Full time

Become a part of our caring community and help us put health first. Humana Healthy Horizons is seeking a Provider Support Model Lead, Provider Engagement to support new Medicaid markets in standing up the Provider Engagement functions, including people, processes, and tools, in alignment with Medicaid segment standards and contractual requirements.

This role is responsible for creating and maintaining segment best practices on Provider Engagement staffing, processes, tools to support PCPs, pediatricians, as well as specialty providers (e.g, BH, LTSS) in improving their quality and VBP performance. The Provider Support Model Lead partners cross-functionally on matters of significance to ensure we deliver best-in-class provider experiences and are compliant with related contractual requirements.

This role is responsible for creation of and implementation of process and solutions for both standard and non-standard contract requirements, and/or resolving complex technical and operational challenges. As a result, this Lead position requires a solid understanding of how organization capabilities interrelate across department(s).

Provider Support Model Lead Key Role Objectives

Segment Best Practices

• Lead Humana provider engagement strategy to drive optimal provider experience and performance in alignment with organizational goals and industry trends.
• Maintain and enhance our Medicaid Provider Support Model to create standardized and scalable processes, resources, and tools (80% repeatable staffing, processes, technology) related to Provider Engagement functions.
• Develop resources for market Provider Engagement staff to use in supporting PCPs, pediatricians, OB/GYNs, BH, and LTSS providers in VBP arrangements. Partner closely with Medicaid VBP team to ensure resources align with goals of core VBP models.
• Lead development of practice transformation strategy/program that markets can adopt.
• Design new innovations and solutions to ensure our Medicaid Provider Support Model is industry competitive and drives positive outcomes and make available for new market rollout.
• Consult with active markets on strategies for improving provider performance and VBP engagement, as appropriate.
• Improve segment/80% standard operating procedures over time to drive efficiencies and repeatable processes for new market implementations.

New Market Implementation

• Responsible for effective and timely implementation of provider engagement business functions in new Medicaid markets, including but not limited to local market provider engagement department staffing and standard operating procedure development, tools and provider visit documentation, and development and execution of Provider Engagement plan.
• Lead creation of and maintenance of the Provider Support Model implementation handbook specific to Provider Engagement.
• Responsible to create processes and materials to stand up Provider Engagement teams and processes in Medicaid markets.

Examples of New Market Support

• Assist with creation of resources for providers to meet identified cost and quality improvement opportunities.
• Develop processes for the market to monitor and support VBP performance for applicable providers.
• Develop processes for the market to assess provider value-based maturity and identify opportunities to advance along the VBP continuum.
• Develop process for market to evaluate and approve any non-standard VBP terms requested by providers.
• Assist new markets in identifying providers to participate in Year 1 VBP models.
• Assist new markets in identifying primary care providers who need access to Compass, identify which providers need BAAs, and work with Medicaid VBP to establish access.
• Assist with interviewing and hiring of new market Provider Engagement staff and department leadership and serve as a mentor during the implementation period.
• Assist market in training of staff on market tools, such as QuickBase and Compass, available reporting, Joint Operating Committees, and market processes.