Director Provider Engagement

Profile

Description

Humana Healthy Horizons is seeking a Director, Provider Engagement who will oversee a team of Provider Engagement associates that grow positive, long-term relationships with contracted primary care providers in order to drive high quality, high value care for Humana members. The Director, Provider Engagement is a content expert in value-based agreements, performance improvement and resolution of operational barriers impacting provider performance. This individual represents Humana Healthy Horizons in Florida with providers, establishes policies and operating procedures for Provider Engagement representatives, 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 Vice President of Operations.

Responsibilities

Directs the Provider Engagement strategy to support and encourage high performance in Humana's primary care value-based payment arrangements and participation in Humana's quality improvement and compliance initiatives

Manages and professionally develops Provider Engagement managers and associates in assigned geographical area; onboard and train new provider engagement team members

Actively monitors and assesses PCP contractual performance at a network and participating health center level, including financial and quality targets

Designs and oversees structure for establishing, monitoring and reporting on formal corrective action plans as warranted

Establishes process and monitors feedback from individual providers to resolve issues and inform improvements to Humana processes; identifies and speaks intelligently to the areas of success and areas of improvement needed to enhance overall contractual performance

Collaborates with Network Contracting, Finance and Quality leadership to increase proportion of provider network in value-based payment arrangements

Partners with Community Engagement team to link community-based health initiatives and primary care offices to comprehensively support member needs

Establish policies and operating procedures for team of Provider Engagement representatives and maintains documentation on provider engagement and network efforts in established systems and tools

Monitor associate performance against key performance indicators and adherence to contractual commitments and requirements

Represents the local market leadership in planning and strategy, including RFP subject matter strategy and responses, corporate initiatives, etc.

Required Qualifications

Bachelor's Degree

8 or more years of progressive experience in provider network management, provider contracting, quality

5 or more years management experience

3 or more years of experience working with value based contracts

Exceptional relationship management skills

Strong written and verbal communication skills and experience presenting to varied audiences.

Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance

Ability to manage multiple competing priorities in a fast-paced environment

Must reside in the state of Florida

If progressed to offer, you will be required to:

Provide proof of full vaccination OR

Commit to weekly testing, following all CDC protocols, OR

Provide documentation for a medical or religious exemption consideration

Preferred Qualifications

Experience with the Medicaid, preferably in Florida

Additional Information

Direct Reports: 15-25 direct and indirect reports

Travel: up to 50% to provider offices and Humana Healthy Horizons location in Tampa, FL for meetings/training

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com