Role: Provider Engagement Executive
Assignment: Sr. Products
Location: Austin, TX
Healthcare isn’t just about health anymore. It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. At Humana, we want to help people everywhere, including our associates, lead their best lives. We support our associates to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our associates fresh perspective, new insights, and exciting opportunities to grow their careers. At Humana, we’re seeking innovative people who want to make positive changes in their lives, the lives of our members, and the healthcare industry as a whole.
Be a part of the Market Operations world – Connect with consumers and expand future opportunity.
Humana is seeking a Provider Group Engagement Manager who will have responsibility for the establishment, maintenance and oversight of various Provider risk agreements and relationship. The role will facilitate & provide detailed analysis, reporting, training, education and support to Provider groups to promote financial success and membership growth. The Manager will make recommendations to market leadership on product design, provider contract terms & negotiations, key performance indicators and engagement metrics.
Oversee the set-up of Humana's service fund and Provider file maintenance for Provider groups.
Manage and deliver reporting and analysis on profitability and performance for internal and external entities on Provider groups
Perform and/or collaborate with Finance on analysis of trend issues, cost savings opportunities, utilization patterns, and other analysis as needed on Provider groups
Make recommendations to market leadership through detailed analysis/consideration of financial and operational implications to Humana and the groups
Serve as focal point for Provider risk group questions regarding financial settlement, delegation, claims adjudication and funding
Successfully facilitate & implement various initiatives with groups (HEDIS, MRA, STARS, etc.)
Health care or managed care with Provider Contracting, Network Management or Provider Relations experience
Ability to partner with senior leadership on strategic initiatives
Proven planning, preparation and presenting skills
Demonstrated ability to manage multiple projects and meet deadlines
Comprehensive knowledge of Microsoft Office PowerPoint and Excel
Ability to travel local and overnight as needed with most of the travel being local
Established knowledge of reimbursement and bonus methodologies
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
This role reports to the Market VP.
At Humana, we know your well-being is important to you, and it’s important to us too. That’s why we’re committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. If you share our passion for helping people, we likely have the right place for you at Humana.
If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.
Title: Provider Engagement Executive - Austin, TX
Requisition ID: 177292