Senior Provider Engagement Professional

Employment Type: Full-time

Position Overview

Become a part of our caring community and help us put health first. Humana Gold Plus Integrated is seeking a Senior Provider Engagement Professional. 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's work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Provider Engagement Professional's responsibilities include:

• Representing the scope of health plan/provider relationships 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
  • Other areas related to provider performance, member experience, market growth, provider experience, and operational excellence.
• Beginning to influence department strategy.
• Making decisions on moderately complex to complex issues regarding the technical approach for project components, working without direction.
• Exercising considerable latitude in determining objectives and approaches to assignments.

Requirements

• Location: Must live in the State of Illinois and be able to travel throughout Illinois as needed for the role (up to 75%).
• Education & Experience:
  • Bachelor’s Degree along with 3 or more years of progressive experience in managed care operations, including network management and provider relations.
  • OR Equivalent work experience along with 5 or more years of progressive experience in managed care operations, including network management and provider relations.
• Provider Experience: Experience working for or with key provider types (such as primary care, FQHCs, hospitals, nursing facilities, and/or HCBS and LTSS providers).
• Illinois Market Knowledge: Prior experience working in and strong understanding of Illinois Medicaid, provider landscape, and networks.
• Skills:
  • Proven planning, preparation, and presenting skills.
  • Established knowledge of reimbursement and bonus methodologies.
  • Demonstrated ability to manage multiple priorities in a fast-paced environment.
  • Experience working in a matrixed organization and influencing change and direction.
  • Intermediate to advanced knowledge of Microsoft Suite applications, specifically Word, Excel, and PowerPoint.
• Driver Safety Program: This role is part of Humana’s Driver Safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.

Preferred Qualifications

• Master’s degree.
• Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses, and quality/bonus performance.
• Comprehensive knowledge of Medicare policies, processes, and procedures.

Work at Home Requirements

• Internet: A minimum download speed of 25 Mbps and an upload speed of 10 Mbps is recommended. Wireless, wired cable, or DSL connection is suggested. Satellite, cellular, and microwave connections can be used only if approved by leadership.
• Internet Reimbursement: Associates who live and work from home in California, Illinois, Montana, or South Dakota will be provided with a bi-weekly payment for their internet expense.
• Equipment: Humana will provide home or hybrid home/office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Workspace: Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Additional Information

• Workstyle: Remote – work at home; must live in the State of Illinois.
• Travel: Up to 75% travel in the field across the state of Illinois.
• Core Workdays & Hours: Typically, 8 am - 5 pm Monday – Friday Central Standard Time (CST) with flexible scheduling (i.e., occasional nights and weekends).
• Benefits: Benefits are effective on day one.