Become a part of our caring community and help us put health first
 

The Senior Provider Engagement Professional- Practice Transformation is responsible for driving provider performance programs, goals and improvement metrics for network providers and partnerships. The Engagement Professional is an integral part of a cross-functional, collaborative organization which includes Provider Service Experience, Network Optimization, Clinical Services, Value-Based contracting, HEDIS and Risk Adjustment. Reporting to the Associate Director and/or Market Development Advisor, the Sr. Provider Experience Professional- ensures the effective management of provider performance programs for Humana Healthy Horizons in Ohio.

The Senior Provider Engagement Professional- Practice Transformation 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. The Senior Provider Engagement Professional will work with key providers throughout the state, including Primary Care Providers (PCPs), FQHCs/RHCs, Pharmacies and Hospital Systems.  Barring COVID restrictions, regional travel will be an expected part of this role.

This position requires the candidate to reside within the State of Ohio.

• Up to 15% Travel within the State of Ohio

Responsibilities:

• Leading and managing the Provider Performance team for Ohio Medicaid and engaging with providers and internal stakeholders to drive high performance in quality and cost efficiency.
• Designing and implementing programs to maintain positive relationships between the health plan, physician, providers and practice managers.
• Supporting HEDIS & Risk Adjustment initiatives and Ohio Department of Medicaid quality initiatives for PRAF, Diabetes and other targeted campaigns.
• Monitor all feedback from individual providers to inform improvements to Humana processes.
• Develop provider training/orientation materials and timely communications of changes to the Ohio Department of Medicaid program.
• Acting as provider performance knowledge leader, lead external and internal training for providers and associates related to Ohio Department of Medicaid value-based programs to include Episodes of Care, Comprehensive Maternal Care, CICIP and other initiatives.  
• Monitor provider’s performance against key performance indicators and contractual commitments and requirements. Work with health plan leadership to improve performance, develop and implement quality improvement initiatives.
• Supporting in the onboarding and training of new provider engagement and provider transformation team members on performance programs and initiatives.
• Collaborates with internal stakeholders on development and implementation of value-based programs and alternative payment models.
• Acts as a supporting function of the broader Provider Experience team.

Use your skills to make an impact
 

Required Qualifications

• This position requires the candidate to reside within the State of Ohio.
• Bachelor's Degree and/ or equivalent experience
• 5 or more years of Provider Relations experience, Health care or Managed care, Provider Contracting, Network Management and Claims knowledge
• Experienced in Medicaid/Medicare operations
• Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies
• Demonstrated ability to manage multiple projects and meet deadlines
• Acting as provider performance knowledge leader, lead external and internal training for providers and associates related to Ohio Department of Medicaid value-based programs to include Episodes of Care, Comprehensive Maternal Care, CICIP and other initiatives.  
• Monitor provider’s performance against key performance indicators and contractual commitments and requirements. Work with health plan leadership to improve performance, develop and implement quality improvement initiatives.
• Supporting in the onboarding and training of new provider engagement and provider transformation team members on performance programs and initiatives.
• Collaborates with internal stakeholders on development and implementation of value-based programs and alternative payment models.
• Acts as a supporting function of the broader Provider Experience team.
• 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. 

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Preferred Qualifications

• Master's Degree
• Proficiency in analyzing and interpreting quality improvement trends for health care providers, and quality/bonus value based performance
• Comprehensive knowledge of Medicaid policies, processes and procedures

Additional Information

This position requires the candidate to reside within the State of Ohio.

• Up to 15% Travel within the State of Ohio

Alert:

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

Interview Format: HireVue

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

WAH Home Statement:

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

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Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$63,400 – $87,400 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of  Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.