Humana

Supervisor, Provider Engagement

San Antonio, Texas, United States

Not SpecifiedCompensation
Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, Managed CareIndustries

Requirements

Candidates must possess a Bachelor's degree or a minimum of 5 years of supervisory experience in the dental industry. A minimum of 4 years of experience in healthcare or managed care with provider contracting, network management, or provider relations is required, along with at least 2 years of prior supervisory experience in a fast-paced operational setting driven by quality metrics. Proven planning, preparation, and presenting skills are essential, as is established knowledge of reimbursement and bonus methodologies, and the demonstrated ability to manage multiple projects and meet deadlines. A passion for contributing to an organization focused on continuously improving consumer experiences is also required. Proficiency in analyzing and interpreting financial trends for healthcare costs, administrative expenses, and quality/bonus performance, as well as comprehensive knowledge of Medicare policies, processes, and procedures, are preferred qualifications. The self-provided internet service must meet a minimum of 25 Mbps download and 10 Mbps upload speed, with wireless, wired cable, or DSL connection suggested.

Responsibilities

The Supervisor, Provider Engagement is responsible for developing and growing positive, long-term relationships with physicians, providers, and healthcare systems to support and improve financial and quality performance. This role involves representing the health plan/provider relationship across various areas including financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, and operational improvements. The supervisor will also perform escalated or more complex work, supervise a group of associates, coordinate and provide day-to-day oversight, ensure consistency in execution across the team, and hold team members accountable for following established policies. Occasional travel to Humana's offices for training or meetings may be required.

Skills

Provider Engagement
Provider Contracting
Network Management
Provider Relations
Managed Care
Health Plan Operations
HEDIS
STARs Performance
Reimbursement
Supervision
Planning
Presentation

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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