Senior Provider Engagement Professional

fully flexible
Work set-up: 
Full Remote
Contract: 
Experience: 
Senior (5-10 years)
Work from: 

Offer summary

Qualifications:

Bachelor's Degree required, Master's Degree preferred., Minimum of 5 years of healthcare or managed care experience, specifically in Provider Contracting, Network Management, or Provider Relations., Knowledge of reimbursement and bonus methodologies, financial trends, and Medicare policies., Proven skills in planning, presentation, managing multiple projects, and contributing to organizational improvement..

Key responsibilities:

  • Develop and maintain long-term relationships with healthcare providers and systems.
  • Support and improve financial and quality performance within provider relationships.
  • Analyze complex data and situations to inform decision-making and strategy.
  • Represent the health plan's interests across various areas like clinical management, data sharing, and operational improvements.

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Humana Health, Sport, Wellness & Fitness XLarge https://careers.humana.com/
10001 Employees
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Job description

Become a part of our caring community and help us put health first
The Senior Provider Engagement Professional develops and grows positive, longterm relationships with physicians, providers and healthcare systems in order to support and improve financial and quality performance within the contracted working relationship with the health plan. The Senior Provider Engagement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an indepth evaluation of variable factors.

The Senior Provider Engagement Professional represents the scope of health planprovider 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. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.


Use your skills to make an impact

Required Qualifications

  • Bachelors Degree
  • Must reside in Ohio
  • 5 or more years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience
  • Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies
  • Demonstrated ability to manage multiple projects and meet deadlines
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences
    • Preferred Qualifications

      • Masters Degree
      • Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and qualitybonus performance
      • Comprehensive knowledge of Medicare policies, processes and procedures
        • Additional Information

          As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decisionmaking ability. HireVue 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.

          To ensure Home or Hybrid HomeOffice employees’ ability to work effectively, the selfprovided internet service of Home or Hybrid HomeOffice employees must meet the following criteria:

          At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; 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 biweekly payment for their internet expense.
          Humana will provide Home or Hybrid HomeOffice employees with telephone equipment appropriate to meet the business requirements for their positionjob.
          Work from a dedicated space lacking ongoing interruptions to protect member PHI HIPAA information.

          Travel: While this is a remote position, occasional travel to Humanas offices for training or meetings may be required.

          Scheduled Weekly Hours

          40

          Pay 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.


          $71,100 $97,800 per year


          This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company andor individual performance.

          Description of Benefits

          Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support wholeperson wellbeing. 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), shortterm and longterm disability, life insurance and many other opportunities.


          About us
          Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.

Required profile

Experience

Level of experience: Senior (5-10 years)
Industry :
Health, Sport, Wellness & Fitness
Spoken language(s):
English
Check out the description to know which languages are mandatory.

Other Skills

  • Presentations
  • Time Management

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