Humana

About Humana

 

Job Category:

Market Strategy - Engagement

Country:

United States

Postal Code:

72756

Approximate Salary:

Not Specified

Position Type:

Full Time

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Provider Engagement Professional - Clinical Consultant

Humana - Rogers, Arkansas

Posted: 08/31/2018

Description

The Provider Engagement Professional 1 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 1 work assignments are often straightforward and of moderate complexity.

Responsibilities

Be a part of our Clinical Team – you will engage and collaborate with our health care providers to enable our members to develop lifelong wellbeing and health by identifying opportunities to enhance care delivery:

  • Participate in internal Provider Engagement team’s strategy/planning meetings
  • Consult with internal resources to identify opportunities for improving provider/member outcomes as related to gaps in quality care and/or disease management program participation
  • Facilitate discussions with provider practice resources on improvement opportunities, plan and partner on improvement initiatives, and monitor outcomes
  • Facilitate the engagement of members in Humana’s clinical programs by educating, promoting and supporting provider practice resources in these efforts
  • Other duties as assigned

               

Role Essentials

  • LPN/RN Nursing Degree with Active nursing license
  • Ability to be licensed in multiple states without restrictions
  • Prior clinical experience and expertise preferably in an acute care or provider setting practice
  • Knowledge and experience working with nationally established clinical quality guidelines and measurement sets such as HEDIS/NCQA or Joint Commission Standards for Accreditation
  • Understanding of clinical programs
  • Ability to work with a team
  • Strong analytical skills, able to research, manipulate and interpret data
  • Ability to measure, monitor, and track improvements in clinical care utilization
  • Ability to demonstrate problem solving skills
  • Organizational and prioritization skills
  • Valid driver’s license and dependable transportation necessary
  • Excellent public speaking skills

Role Desirables

  • Education: Associate’s or Bachelor’s Degree
  • Health Plan experience
  • Previous Medicare/Medicaid Experience a plus
  • Call center or triage experience
  • Utilization management knowledge and experience
  • Provider and member rewards program knowledge and experience
  • Experience in a state and/or federally regulated health care environment
  • Understanding of medical coding

Scheduled Weekly Hours

40

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