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Provider Engagement Executive

Role overview

Qualifications

  • 6 or more years of health care or managed care operations experience including provider relations and/or contracting
  • Experience working with HEDIS and/or Stars measures and programs
  • 2 or more years of project management experience partnering with senior leadership on strategic initiatives
  • Comprehensive knowledge of Medicare policies, processes and procedures

Responsibilities

  • Develop and grow positive, long-term relationships with physicians, providers and healthcare systems
  • Support and improve financial and quality performance within the contracted working relationship with the health plan
  • Represent the scope of health plan/provider relationships across various performance areas
  • Exercise independent judgment and decision making on complex issues regarding job duties

Key facts

Other skills

  • Communication
  • Decision Making
  • Teamwork
  • Problem Solving

About the company

Humana logo

Humana

Health, Sport, Wellness & Fitness

At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.

Company details

Company typeXLarge
IndustryHealth, Sport, Wellness & Fitness
Company size10001

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Job description

Become a part of our caring community
 

The Provider Engagement Executive develops and grows positive, long-term 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 Provider Engagement Executive works on problems of diverse scope and complexity ranging from moderate to substantial.

The Provider Engagement 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. 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.


Use your skills to make an impact
 

Required Qualifications

  • 6 or more years of health care or managed care operations to include provider relations and/or provider contracting

  • Experience working with HEDIS and/or Stars measures and programs

  • 2 or more years of demonstrated project management experience and partnering with senior leadership on strategic initiatives.

  • Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies.

  • Demonstrated ability to manage multiple projects and meet deadlines.

  • Comprehensive knowledge of Medicare policies, processes and procedures.

  • Must reside in either Phoenix, AZ or Denver, CO with the ability to travel as needed, including overnight within the region (CA, NV, AZ, CO, NM)

Preferred Qualifications

  • Bachelor's Degree

  • Phoenix, AZ location is highly preferred

  • Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance.

Travel Information

While this is a remote position, travel to value-based provider groups and regional and corporate Humana offices for training or meetings may be required.

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 decision-making 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.

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.

Work at Home Requirements
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 required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary.

Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's 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.


 

$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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 07-17-2026


About us
 

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.


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.

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Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
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