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Job Information

Humana Provider Engagement Executive in Columbia, South Carolina

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 or more 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

  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences

  • Ability to travel within the region up to 30% of the time

Preferred Qualifications

  • Master's Degree

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

  • Understanding of CMS Quality Metrics (Stars, HEDIS, etc.)

  • Understanding of Value Based programs

  • Comprehensive knowledge of Medicare policies, processes and procedures

Additional Information

This position will be remote/work at home, however, you must live in Upstate/Midlands area of South Carolina as you will be required to travel to provider offices within that region.

Scheduled Weekly Hours

40

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