at Humana in Bossier City, Louisiana, United States
Humana Healthy Horizons in Louisiana is seeking Associate Director, Provider Engagement will oversee 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, Provider Engagement is a content expert in value-based contracting, performance improvement, HEDIS and quality improvement. This individual represents Humana Healthy Horizons 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 Director, Provider Services.
+ Establishes policies and operating procedures for team of provider engagement representatives.
+ Guides engagement strategy to support and encourage high performance in Humana’s value-based payment arrangements and participation in Humana’s quality improvement and compliance initiatives.
+ Monitors all feedback from individual providers to inform improvements to Humana processes.
+ Monitors team’s performance against key performance indicators and contractual commitments and requirements. Work with health plan leadership to improve performance, as needed.
+ Represents the local market leadership in planning and strategy with internal corporate partners to ensure cross-department alignment and communication.
+ Leads and participates in Joint Operating Committee and other provider engagement meetings internally and externally.
+ Ensures compliance with the state’s Managed Care Contractual requirements for supporting providers in quality improvement and value-based payment arrangements.
+ Develops and leads staff to foster positive provider relationships and contribute to provider experience initiatives and projects to assist providers along the value based care continuum.
+ Creates and collaborates on strategy for Medicaid provider network, including VBP contracting approaches and deployment of value-based care models to assure long term mutually successful provider relationships.
+ Works with internal corporate partners and finance to increase proportion of provider network in value-based payment arrangements.
+ Ensures positive provider relationships and contribute to provider retention in Humana’s Medicaid networks.
+ Onboard and trains new provider engagement team members.
+ Must reside in the state of Louisiana.
+ Bachelor’s Degree or equivalent work experience.
+ 5 or more years of progressive experience in managed care operations, including network management, value-based payment, and/or quality.
+ 3+ years prior leadership and management experience.
+ Comprehensive knowledge of Medicaid policies, processes and procedures, including thorough understanding of managed care contracts, including contract language and reimbursement.
+ Intermediate to advance proficiency in MS Programs specifically, Excel.
+ 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.
+ Exceptional relationship management skills.
+ Strong leadership and team building skills.
+ Excellent written and verbal communication skills and experience presenting to varied audiences.
+ Ability to manage multiple competing priorities in a fast-paced environment.
+ 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.
+ Must have the ability to provide a high speed DSL or cable modem for a home office.
+ A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
+ Satellite and Wireless Internet service is NOT allowed for this role.
+ A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
+ Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.
+ MBA or Clinical Degree (e.g., RN, APRN, PA) and/or experience working in a healthcare administration or quality improvement setting.
+ Experience with Medicaid, including network adequacy requirements and standards for value-based payment and quality improvement.
+ Experience with value based contracting and strategy development.
+ Diverse clinical experience, including experience working with behavioral health providers, OB/GYNs, and pediatricians, to drive performance and quality improvement.
+ Workstyle : Hybrid Home - Works 1 – 2days/week in Humana’s Baton Rouge or Metairie, LA office location and 3 – 4 days remotely.
+ Travel: Up to 50%.
+ Direct Reports: Up to 10 Associates.
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers 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 next round of interviews.
Scheduled Weekly Hours