Humana

About Humana

 

Job Category:

Market Strategy - Engagement

Country:

United States

Postal Code:

60290

Approximate Salary:

Not Specified

Position Type:

Full Time

Senior RN Provider Clinical Professional

Humana - Chicago, Illinois

Posted: 11/14/2018

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

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

  • RN license required
  • 5 years experience in a Clinical setting and strong knowledge around STARS and Quality is required.
  • 5 years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience
  • 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 able to travel within the Greater Illinois Region

Preferred Qualifications

  • 5 years experience in addressing and closing open Gaps in care.
  • Comprehensive knowledge of Medicare policies, processes and procedures

Additional Information

Scheduled Weekly Hours

40

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