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.
4+ years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience
Experience and understanding of Managed Care
Strategic thinking and planning capabilities; organized and detail-oriented
Excellent written and verbal communication skills
Excellent relationship building skills with both internal and external partners
Willingness to manage and prioritize diverse projects
Business and financial acumen in the health care field
Reliable transportation with the ability to travel within the Chattanooga Market
Understanding of HEDIS/Stars measures and metrics
Understanding of Medicare Risk Adjustment
2+ years of demonstrated project management experience and partnering with senior leadership on strategic initiatives
Understanding of managed care reimbursement methodologies
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
This role is “remote/work at home”, however you must live within the Chattanooga region, in order to be considered for this position as travel may be be required to external provider locations and into the Humana office, on occasion for meetings, training, etc.
Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.
WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Scheduled Weekly Hours