Senior Provider Engagement Professional
Humana

Charlotte, North Carolina

Posted in Insurance
6 days ago


Job Info


Description

The Senior Provider Engagement Professional 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 Senior Provider Engagement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Provider Engagement Professionalfacilitates the health plan/provider relationship across such areas as HEDIS and Stars performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding,operational improvements, member experience, market growth, provider experience and operational excellence. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed somewhat independently, without constant direction. Exercises considerable latitude in determining objectives and approaches to assignments, with input from collaborating partners.

Required Qualifications

  • 5 or more years of health care experience, preferably managing value based partnerships (and/or having provider contracting, network management or provider relations experience)
  • Established knowledge of value-based HEDIS and non-HEDIS metrics as well as provider incentive methodologies
  • Demonstrated ability to manage multiple projects and meet deadlines
  • Proven relationship building, planning, preparation and presentation skills
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
  • Bachelor's Degree
  • Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality recognition performance
  • Comprehensive knowledge of Medicare policies, processes and procedures
Additional Information

This role will cover the South-Central region of North Carolina. The ideal candidate will live within this region and will be required to travel to provider offices within the State as necessary

Scheduled Weekly Hours

40




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