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The Associate Director, Provider Engagement oversees a team of associates that grow positive, long-term relationships with contracted providers in order to drive high quality, high value care for Humana members. The Associate Director is a content expert in value-based contracting, performance improvement, and HEDIS and quality improvement. This individual represents Humana Healthy Horizons in Illinois with providers, establishes policies and operating procedures for Provider Engagement Associates, promotes associate development, and monitors team performance against key performance indicators or contractual requirements. This is a collaborative role requiring critical thinking and problem-solving skills, independence, leadership, a strategic mindset, and attention to detail. This position reports to the plan's Director, Provider Services.
Key Role Objectives
- Establish policies and operating procedures for team of provider engagement representatives
- Guide engagement strategy to support and encourage high performance in key adult and child quality measures and Humana's value-based payment arrangements, closure of care gaps, and participation in Humana's quality improvement and compliance initiatives
- Develop and execute on provider outreach campaigns related to quality metrics, quality improvement, and value-based payment models, in partnership with the market Quality team and other internal partners
- Monitor all feedback from individual providers to inform improvements to Humana processes
- Monitor team's performance against key performance indicators and contractual commitments and requirements. Work with health plan leadership to improve performance, as needed
- Represent the local market leadership in planning and strategy with internal corporate partners to ensure cross-department alignment and communication
- Work with internal corporate partners to increase proportion of provider network in value-based payment arrangements
- Ensure positive provider relationships and contribute to provider retention in Humana's Medicaid networks
- Onboard and train new provider engagement team members
Use your skills to make an impact
Required Qualifications
- Must reside in the state of Illinois.
- Bachelor's degree
- Experience with the Illinois Medicaid MCO contract, including value-based payment and quality improvement standards.
- 6 or more years of progressive experience in managed care operations, including value-based payment, provider performance improvement and quality
- Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses, and quality/bonus performance
- Proficiency in quality improvement principles and analyzing quality metrics, such as HEDIS, to drive higher performance · Prior experience working in and strong understanding of Medicaid and Medicaid key provider types, including pediatrics, OB/GYN, and behavioral health
- Exceptional relationship management skills
- Two plus years of demonstrated leadership and management experience and partnering with senior leadership on strategic initiatives
- Comprehensive knowledge of Medicaid policies, processes, and procedures, including thorough understanding of managed care contracts (e.g., contract language and reimbursement)
- Diverse clinical experience, including experience working with LTSS and behavioral health providers, OB/GYNs, and pediatricians, to drive performance and quality improvement
- Ability to travel as needed throughout Illinois
Preferred Qualifications
- Master's Degree
- Clinical Degree (e.g., RN, APRN, PA) and/or experience working in a healthcare administration or quality improvement setting
- Experience with the Illinois Medicaid MCO contract, including and standards for value-based payment and quality improvement. · Experience building teams from the ground up in a fast-paced implementation environment
This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.
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 suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
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.
$115,200 - $158,400 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
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.
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