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

Humana Gold Plus Integrated is seeking a Senior Provider Engagement Professional who develops and grows positive, long-term relationships with physicians, providers and healthcare systems 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.

The Senior Provider Engagement Professional roles and responsibilities include:

• 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.
• Make 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.

Use your skills to make an impact
 

Required Qualifications

• Must live in the State of Illinois and be able to travel throughout Illinois as needed for role (up to 75%).
• Bachelor’s Degree along with 3 or more years of progressive experience in managed care operations, including network management and provider relations -OR- equivalent work experience along with 5 or more years of progressive experience in managed care operations, including network management and provider relations
• Experience working for or with key provider types (such as primary care, FQHCs, hospitals, nursing facilities, and/or HCBS and LTSS providers)
• Prior experience working in and strong understanding of Illinois Medicaid, provider landscape and networks. 
• Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies.
• Demonstrated ability to manage multiple priorities in a fast-paced environment.
• Experience working in a matrixed organization and influencing change and direction.
• Intermediate to advanced knowledge of Microsoft Suite applications, specifically Word, Excel, and PowerPoint.
• This role is a 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 100,000/300,000/100,000 limits. 

Preferred Qualifications

• Master’s degree.
• 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.

Work at Home Requirements

• 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.
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided with a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates 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

• Workstyle: Remote – work at home; must live in the State of Illinois.
• Travel: Up to 75% travel in the field across the state of Illinois.
• Core Workdays & Hours: Typically, 8-5 pm Monday – Friday Central Standard Time (CST) with flexible scheduling (i.e. occasional nights and weekends).
• Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more.....

Interview Format

As part of our hiring process, we will be using exciting interviewing technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers with an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to the 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

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.

 

$71,100 - $97,800 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.

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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.