Provider Engagement Executive - Vancouver WA/Portland OR
Posted on: 6 Feb 2021
Vancouver, WA
Job Description
Description
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.
Responsibilities
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.
Required Qualifications
* Bachelor's Degree
* 5+ years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience
* 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 all Microsoft Office applications
* Ability to travel as needed
* Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
* Master's Degree
* Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance
* Comprehensive knowledge of Medicare policies, processes and procedures
Scheduled Weekly Hours
40
Humana
Louisville, KY
Humana Inc., together with its subsidiaries, operates as a health and well-being company in the United States. The company offers medical and supplemental benefit plans to individuals. It also has contract with Centers for Medicare and Medicaid Services to administer the Limited Income Newly Eligible Transition prescription drug plan program; and contracts with various states to provide Medicaid, dual eligible, and long-term support services benefits.
In addition, the company provides commercial fully-insured medical and specialty health insurance benefits comprising dental, vision, and other supplemental health and voluntary insurance benefits; financial protection products; and administrative services only products to individuals and employer groups, as well as military services, such as TRICARE South Region contract.
Further, it offers pharmacy solutions, provider services, predictive modeling and informatics services, and clinical care services, such as home health and other services to its health plan members, as well as to third parties. As of December 31, 2018, the company had approximately 17 million members in medical benefit plans, as well as approximately 6 million members in specialty products. Humana Inc. was founded in 1961 and is headquartered in Louisville, Kentucky.
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IndustryHealthcare
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No. of Employees41,600
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Website
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Jobs Posted1359
