The Provider Engagement, Clinical Quality Executive represents the scope of health plan/provider relationship across such areas as financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, operational improvements and other areas as they relate to provider performance, member experience, market growth, provider experience and operational excellence. This work focuses on areas of clinical emphasis. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.
Collaborate with the market provider engagement/contracting/network optimization/practice transformation team to:
o Develop provider engagement strategy, including VBP, high-volume FFS and dual-eligible when applicable
o Determine meeting type (JOC, Clinical/Quality, Operation) and frequency
o Develop and/or standardize provider meeting presentations and reporting package
o Create provider scorecard
o Create market provider performance profiling and develop strategy to target low performing providers
o Develop EMR interoperability strategy
o Develop Compass and Availity CQV adoption strategy
Oversees, plans, and implements provider facing QI initiatives, including scorecard development/monitoring, gaps in care reports, and CAHPS survey results/strategy
Key contributor to development and oversight of care coordination function (CCF) and outcome reporting
Key contributor to market planning sessions on provider risk readiness evaluation and timing
Key contributor quality strategy for all provider facing activities, included participating in integrated care internal workgroups
Key contributor to market value-based provider incentive programs, including PCP, specialist, and hospital
Ensure alignment of Value based programs with state goals for primary care spend
Required Qualifications
Registered Nurse with an active license in the state of Oklahoma
3+ years in clinical strategy and implementation, focused on provider outcomes
Experience in healthcare, payor clinical programs, and value-based care organizations
Direct experience working with providers
Ability to drive cross functional teams to alignment
Knowledge of an integrated care delivery system
Must reside in OKLAHOMA
Preferred Qualifications
Bachelor’s Degree
Experience in clinical practice working with or within a provider organization
Experience implementing Quality Improvement initiatives and strategies
Experience using healthcare data and analytics to inform program development
Additional Information
This position is open to work hybrid in Oklahoma.
Work at Home Criteria
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.
Interview Format
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue 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.
Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
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 veteran status. 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.
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