Humana Job Openings – Director, Provider Engagement

Job Description:

The Director of Long Term Care Provider Engagement Services oversees the plan’s strategic provider services, engagement, and network development. This role’s success requires collaboration, critical thinking skills, communications, independence, leadership, a strategic mindset, and attention to detail.

Job Responsibilities:

• Work closely with Data Management teams on claims processing, resolution issues, and provider performance tool enhancements.
• Review, assess, and develop outreach strategies based on available and appropriate data; and provide consistent communication of goals/outcomes.
• Collaborate with health system leadership to discuss trends, business growth opportunities, obstacles to service line retention, and results from Provider Relations outreach activities.
• Partner with marketing to develop outreach collateral and strategies to be used uniformly throughout the market.
• Provide market oversight, governance of provider audits, provider surveys, provider service and relations, credentialing, and contract management systems.
• Drives performance and executes on strategic initiatives within the provider network.
• Coordinate workforce development initiatives and work collaboratively with Humana business area leads, direct collaboration with other contracted MCOs and the Department as prescribed.
• Provide market oversight and governance of the management of provider data for the health plan including but not limited to demographics, rates, and contract intent.
• Represent the scope of health plan/provider relationship across such areas as financial performance, incentive programs, quality, clinical management, population health, data sharing, connectivity, documentation and coding, operational improvements and other areas as they relate to LTC provider performance, member experience, market growth, provider experience and operational excellence.
• In coordination with health system leadership, develop annual and quarterly strategic targeting objectives for provider relations team in alignment with market strategies and initiatives.
• Provide oversight and governance of the executed processes for intake and management of provider perceived service failures.
• Support the development and growth of the HCBS network, development of long-term relationships with community-based providers, Custodial Nursing Facility providers, short term Skilled Nursing Facilities, and leverage Humana’s healthcare systems to maintain and improve financial and quality of care performance.
• Maintain all provider services and communication functions to meet LTC regulatory requirements
• Coordinate and collaborate with a matrix team of provider service and contracting representatives to ensure that Humana processes are aligned with State contract and regulatory requirements.
• Retain the plan’s network of providers, creating a qualified, serviceable, and comprehensive network.
• Work closely with Product Teams to ensure new developments align with provider expectations.
• Support provider services activities through payment integrity management, provider education, issue resolution, and claims resolution.
• Ensure compliance with contractual requirements as it relates to the Market network and direct process improvement to address network non-compliance, market strategy and initiatives.

Job Requirements:

• Progressive responsibility in business or government
• Thorough knowledge of Long Term Care and Home and Community Based Services (HCBS) guidelines, rules and requirements
• Working knowledge in the areas of Practice Management, Long-Term Acute Care, home health, home infusion, behavioral health, Nursing Facility, and SNF
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Qualification & Experience:

• 3 or more years of provider contracting or physician network development experience
• Bachelor’s degree
• 6 or more years of management experience, including at least 3 years’ experience with Home and Community Based Services
• Strong experience with Medicaid, Medicare, Dual eligible and LTSS requirements and populations
• 4 or more years of project leadership experience
• Experience with analyzing, understanding and communicating financial trends

Job Details:

Company: Humana

Vacancy Type: Full Time

Job Location: Tampa, FL, US

Application Deadline: N/A

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