Humana Looking For Provider Engagement Professional 2 at Ohio Full Time

The Provider Engagement Professional 2 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 Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities**

The Provider Engagement Professional 2 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. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures

Required Qualifications

• Bachelor’s Degree or equivalent work experience

• 2 – 5 years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience

• Experience with Claims and Operations

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

• Demonstrated ability to manage multiple projects and meet deadlines

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

• This role is part of Humana’s Driver safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100/300/100 limits

• WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10×1 (10mbs download x 1mbs upload) is required.

Preferred Qualifications

• 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

Additional Information

Up to 15% Travel within the State of Ohio

For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.

If progressed to offer, you will be required to:

• Provide proof of full vaccination or commit to testing protocols OR  

• Provide proof of applicable exemption including any required supporting documentation

​​Medical, religious, state and remote-only work exemptions are available.

Scheduled Weekly Hours**

40

Job Type: Full-time

Schedule:

Application Question(s):

• Do you have 2 + years of Health Care or Managed Care with Provider Contracting, Network Management or Provider Relations experience?

Work Location: Multiple Locations