The Provider Engagement, Clinical Executive develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and quality performance and improve member outcomes within the contracted working relationship with the health plan. The Provider Engagement, Clinical Executive works on problems of diverse scope and complexity ranging from moderate to substantial.
The Provider Engagement, Clinical Executive represents the scope of health plan/provider relationship across such areas as, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, and other areas as they relate to provider performance, member experience, market growth, and operational excellence. This work focuses on areas of clinical emphasis. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.
Position Responsibilities
Collaborate with the market provider engagement/contracting/network optimization/practice transformation team to: Develop provider engagement strategy, including VBP, high-volume FFS and dual-eligible when applicable.Participate in meetings with providers and network teams (JOC, Clinical/Quality, Operation).Develop and/or standardize QI/clinical provider meeting presentations and reporting package.Create market provider quality/clinical performance profiling and develop strategy to assist low performing providers to meet clinical targets.Develop EMR interoperability strategy.Oversees, plans, and implements provider facing QI initiatives, including scorecard development/monitoring, gaps in care reports, and CAHPS survey results/strategy.Key contributor to development and oversight of care coordination function (CCF) and outcome reporting.Key contributor to market planning sessions on provider risk readiness evaluation and timing.Key contributor to quality strategy for all provider facing activities, included participating in integrated care internal workgroups.Key contributor to market value-based provider incentive programs, including PCP, specialist, and hospital.DMAS point of contact for workgroups to develop provider strategies to improve member outcomes and close gaps.Liaison to providers to assist in developing strategies to improve clinical outcomes including but not limited to ER utilization, follow up after hospitalizations and preventive screenings.Use your skills to make an impact
Required Qualifications
Bachelor’s’ Degree in a health-related field5 or more years in clinical strategy and implementation, focused on provider outcomes.Experience in healthcare, payor clinical programs, and value-based care organizations.Intermediate to advanced experience working with Microsoft Office Products and reporting systemsDirect experience working with providers.Demonstrated capability to facilitate alignment among cross-functional teamsDemonstrated business and financial acumen.Must reside in Virginia and willing to travel to Provider offices and Market office as needed to attend meetingsPreferred Qualifications
Registered Nurse.5 or more years' experience in clinical practice working with or within a provider organization.Knowledge of an integrated care delivery system.Experience implementing Quality Improvement initiatives and strategies.Experience using healthcare data and analytics to inform program development.Work-At-Home Requirements
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 required; wireless, wired cable or DSL connection is required.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.Additional Information
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive an email correspondence inviting you to participate in a SMS Text Messaging interview. (please be sure to check your spam or junk folders often to ensure communication isn’t missed)
The SMS Text interview, will ask you a series of questions to which you will be using your Cell phone OR Email to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay 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.
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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.