Residential Provider Engagement Professional 2- Southeast WI

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

The Residential Provider Engagement Professional 2 develops and grows positive, long-term relationships with Residential providers in order to support our providers and members in Residential settings. and improve financial and quality performance within the contracted working relationship with the health plan. The Residential Provider Engagement Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. This position works with the member's team on finding Residential placement.

               

• Sustain positive relationships with external and internal stakeholders demonstrating excellent customer service.
• Works collaboratively with stakeholders, members, guardians, providers, and others to implement innovative and cost-effective managed care models/approaches.
• Develops a robust network that supports member choice, increases community connections, which supports dignity and fosters full participation in communities.
• Monitors and ensures contracted provider compliance with federal, state, and contract requirements and adherences to policies and procedures and other regulations.
• Participates in the development and implementation of innovative policies and procedures related to provider contracting, rate setting, and contract compliance.
• Negotiates rates with providers.
• Support network of providers to ensure quality and compliance of family care regulations.
• Educates providers and other stakeholders on contract compliance.
• Works collaboratively with Quality Department in quality activities related to contracted providers.
• Act as an active member to find viable residential options to meet member’s unique needs and outcomes, providing recommendations to the team and members.
• Coordinates and attends meetings with providers in the network and external stakeholders for educational and performance standards purposes, including provider service expectations and/or quality concerns.
• Travel throughout the following counties as needed for provider quality support and follow-up - Jefferson, Kenosha, Walworth, Waukesha, and Columbia

Use your skills to make an impact
 

Required Qualifications

• Bachelor's Degree
• 1 - 5 years of Provider Relations or Managed Care experience

Preferred Qualifications

• Proficiency in analyzing and interpreting financial trends for health care costs, work through budget planning and assess quality performance
• Comprehensive knowledge of Medicare policies, processes and procedures
• Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies
• Demonstrated ability to manage multiple projects and meet deadlines
• Strong communication skills including written and verbal
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Additional Information

• Workstyle: Hybrid Home
• Work Location: Southeast, Wisconsin and surrounding area.
• Travel: up to 20% travel in Southeast WI region
• Typical Work Days/Hours: Monday through Friday, 8:00 am – 4:30 pm CST.

WAH Internet Statement

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a 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 connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Benefits

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

• Health benefits effective day 1
• Paid time off, holidays, volunteer time and jury duty pay
• Recognition pay
• 401(k) retirement savings plan with employer match
• Tuition assistance
• Scholarships for eligible dependents
• Parental and caregiver leave
• Employee charity matching program
• Network Resource Groups (NRGs)
• Career development opportunities

Modern Hire

As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

SSN Alert

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

Scheduled Weekly Hours

40

About us
 

About Inclusa: Inclusa manages the provision of a person-centered and community-focused approach to long-term care services and support to Family Care members across the state of Wisconsin. As a values-based organization devoted to building vibrant and inclusive communities, Inclusa deploys a unique approach to managed care with a trademarked model of support named Commonunity® which focuses on the belief in everyone, and from that belief, the common good for all is achieved. In 2022, Inclusa was acquired by Humana. This partnership will allow us to create a model of care that provides industry-leading support for members across the health care continuum.

About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of  Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.