Humana

About Humana

 

Job Category:

Market Strategy - Engagement

Country:

United States

Approximate Salary:

Not Specified

Position Type:

Full Time

Provider Engagement Professional (HEDIS/Stars) - Northern Virginia

Humana - Work At Home, Virginia

Posted: 11/11/2018

Description

The 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.

Responsibilities

This role will focus on a territory primarily in northern VA and possibly MD. There will be up to 60% travel in this area.

The hours are Mon-Fri, 8am-5pm est.

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.

               

Required Qualifications

  • Bachelor's Degree
  • Experience in health care or managed care with Provider Contracting, Network Management or Provider Relations experience
  • Experience with HEDIS quality measures
  • Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies 
  • Demonstrated ability to manage multiple projects and meet deadlines
  • Proven ability building and maintaining relationships with external partners or vendors.
  • Able to travel 60% in the northern VA area.
  • 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

  • TB screen required for all Onsite roles.

Preferred Qualifications

  • 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
  • Clinical background

Additional Information

As part of our hiring process for this opportunity, we will be using a technology called Montage Voice which allows us to quickly connect and gain valuable information from you about your relevant experience.

 

If you are selected for a phone screen you will receive an email inviting you to participate in a Montage Voice interview. During this call you will be asked a set of questions pertaining to this particular role and you will provide recorded responses. The entire process takes about 15-20 minutes and can be done at your convenience. Your responses will be reviewed and you will be informed if you were selected for an in person or video interview, depending on your location.

Scheduled Weekly Hours

40

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