RN/LPN Senior Provider Engagement Professional

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Job Information
Humana
RN/LPN Senior Provider Engagement Professional
in
Rogers
Arkansas
Description
The Senior Provider Engagement Professional develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order 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.
Responsibilities
The Senior Provider Engagement Professional 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. Makes 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.
Required Qualifications
Bachelor's Degree preferred or 5 years of value-based Health care or managed care with Provider Contracting, Network Management or Provider Relations experience
LPN/RN with current licensure without restrictions with Care Coordination, Acute Hospital background, Clinic experience, Quality Experience and strong critical thinking skills.
Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies
Demonstrated ability to manage multiple projects and meet deadlines while being team focused driving collaboration across departments
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
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
Comprehensive knowledge of clinical impact relating to HEDIS/Stars, Care Management and Community Based Assistance programs.
Proven track record building relationships with providers and health systems
Additional Information
Candidates MUST live in one of these states Oklahoma, Arkansas, Kansas, Missouri, Iowa or Nebraska to be considered.
For this job, associates are required to be fully COVID vaccinated, including booster or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
If progressed to offer, you will be required to:
Provide proof of full vaccination, including booster or commit to testing protocols
*OR  *
Provide proof of applicable exemption including any required supporting documentation
​​Medical, religious, state and remote-only work exemptions are available.
Scheduled Weekly Hours
40

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