Become a part of our caring community
 

The Provider Engagement, Clinical Executive develops and grows positive, long-term relationships with physicians, providers, and healthcare systems. We develop these relationships to support financial and quality performance within the contracted working relationship with the health plan. The Provider Engagement, Clinical Executive works on problems of diverse scope and complexity ranging from moderate to substantial.

The Provider Engagement, Clinical Executive represents the scope of health plan/provider relationship across several areas. These areas include financial performance, incentive programs, quality and clinical management, population health, and data sharing. They also include connectivity, documentation and coding, HEDIS and STARs performance, operational improvements, and other areas. The job relates these other areas to provider performance, member experience, market growth, provider experience, and operational excellence. This work focuses on areas of clinical emphasis. Advise Market leaders to develop functional strategies on matters of significance. Reporting to the Director, Quality Improvement you will work on complex issues and determine the best course of action.

In this role you will, collaborate with the market provider engagement/contracting/network optimization/practice transformation team to:

• Support and execute on the market's provider engagement strategy, including VBP, high-volume FFS and dual-eligible memberships

• Determine meeting type (JOC, Clinical/Quality, Operation) and frequency

• Develop or standardize provider meeting presentations and reporting package(s)

• Create provider scorecards

• Create market provider performance profiling and develop strategy to target low performing providers

• Develop strategy for relaying performance data and detail to physicians, providers, and health systems

• Develop adoption strategy for market and Corporate tools and methodologies

Additionally you will oversee, plans, and implement provider facing QI programs, including scorecard development/monitoring, gaps in care reports, and CAHPS survey results/strategy including Behavioral Health Measures by:

• Contribute to development and oversight of care coordination and outcome reporting

• Help develop the quality strategy for all provider facing activities, included participating in integrated care internal workgroups

• Collaborate on development of market value-based provider incentive programs, including PCP, specialist, hospital, and clinic

NOTE - This is a hybrid role and will require up to 10% travel in and around the Milwaukee area and to provide offices throughout the state.

Use your skills to make an impact
 

Required Qualifications

• Registered Nurse OR a Bachelor's degree in Social Work, Public Health or Health Administration

• Must reside in the state of Wisconsin

• Ability to travel up to 10% in the Milwaukee area AND to provider offices throughout the state

• Minimum 3 years developing or implementing clinical strategies, with a focus on provider outcomes

• Experience in provider clinical programs, payer clinical programs, or value-based care organizations

• Direct experience working with leaders of provider organizations

• Basic knowledge of an integrated care delivery system, Federally Qualified Health Center (FQHC), HEDIS, STARS

Preferred Qualifications

• Experience in clinical practice working with or within a provider organization

• Implement Quality Improvement programs and strategies

• Use healthcare data and analytics to inform program development

Work-At-Home Requirements

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates 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.

• Associates 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 associates 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.

Driving Statement

This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individuals must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.

Mileage reimbursement is provided for work-related travel. Eligible mileage includes:

• Travel from your home to your first work location of the day.

• Travel between client or assignment locations during the workday.

• Travel from your final work location back to your home.

Interview Format

As part of our hiring process for this opportunity, we will use exciting interviewing technology called HireVue to enhance our hiring. HireVue allows us to quickly connect and gain valuable information about your relevant experience. If you are selected for a first-round interview, our team will send you an email correspondence inviting you to participate in a HireVue interview. In this interview, you will receive a set of interview questions, and you will provide recorded or text message responses to each question. For best interview experience use a computer over a phone. You should anticipate this interview to take about 15-20 minutes. We will review your recorded interview, and we will subsequently inform you if you will move forward to next round of interviews.

Humana 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

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.

 

$86,300 - $118,700 per year

 

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

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.

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 a leading U.S. healthcare 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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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.