DescriptionThe 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.
The Senior Provider Engagement Professional 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. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
- Bachelor's Degree
- 3 years in Utilization Review
- Experience Health care or managed care with Provider Contracting, Network Management or Provider Relations experience
- Proven planning, preparation and presenting skills
- Demonstrated ability to manage multiple projects and meet deadlines
- Prior experience working in a provider facing role
- Excellent communication skills, both oral and written, and non-verbal
- Strong relationship building skills
- Ability to travel within the region up to 60% of the time with the possibility of overnight travel
- Thrives in a fast paced, multi-project work environment while still ensuring attention to detail
- Audit and/or process improvement experience
- Knowledge/understanding of regulatory, legislative, and contractual requirements
- 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
- Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); recommended speed is 10Mx1M.
- If selected for this role, a TB screen is required.
- Masters 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 Hours40