Provider Engagement Executive - NYC

Role: Provider EngagementExecutive

Assignment: Market Management

Location: New York City, NY


Humana needs your skills to help ustell a compelling story about healthcare today with our Primary Care Providersacross all lines of business. You will be the defined point of contact forPCPs and responsible for the financial performance of PCPs and IDSes. You willbe successful by creating strategic partnerships with providers to improvehealth efficacy and efficiency and manage provider groups to collective qualityand P&L results and goals. We’re looking for driven, innovativepeople who are interested in using their data-mining and analytical skills tohelp our providers and ultimately our members to achieve lifelong well-beingand help Humana make lasting, positive changes in the healthcare industry.

Assignment Capsule
Be a part of the Market Operationsworld as a Provider Engagement Executive, PEX – Create strategic provider partnershipswith large, engaged providers to improve their experience with Humana. You will manage provider groups to enhancequality and P&L results and goals. Bea strong partner and build relationships with internal stakeholders to create aseamless experience for the provider.

Humana is seeking a StrategicConsultant who will use discipline and expertise to influence, lead and educatepeople and groups in order to optimize Market Operations results.

  • You willinitiate, plan, and frame-up needed process improvements and establishrequirements while consulting and gaining commitment from all key stakeholders.
  • Design and execute profitable growthstrategies
  • Develop and/or implement processesand data sharing structure for delegated relationships
  • Strong facilitation skills with anability to run provider meetings (JOC or PCP meeting) with prioritized specifictopic agenda reflecting entire provider support organization
  • Develop and review Dashboard Metrics(quality, financial, triple AIM) andtranslate into actionable items based on group specifics
  • Ability to train others to use thetools that will make the PCP successful
  • Facilitate clinical education,leveraging clinical experience from your internal partners
  • Abilityto provide actionable financial and operational data, and ensure action plansare implemented to achieve performance goals
  • Bethe defined point of contact for the provider and communication according togroup agreements. Manage all encounterswith delegated providers
  • Identify and manage optimal groupingamong non-risk providers to achieve higher performance and support providerexperience
  • Manage provider continuum,prospecting other providers for value based opportunities
  • Influence provider culture andstrategy to elevate capability of the provider community to support the everchanging healthcare environment.
  • Work to improve EMR capability
  • Partner with the provider and the company to develop capability for sustained, integrated consumer interaction programs building consumer and customer advocacy and loyalty.
  • Possess a deep understanding of segmentation and/or market segment opportunity, product development and product positioning; able to direct the implementation activities for a team of stakeholders.


    Role Essentials

    • Bachelor’s degree
    • 5+ years of progressive experience working in managed care
    • Understanding of STARS and HEDIS measures
    • Experience in implementing strategy to support value-based provider agreements
    • Strategic thinking and planning capabilities; organized and detail-oriented
    • Working knowledge of MS Word, Excel (pivot tables, bars/graphs, etc.) and PowerPoint
    • Excellent written and verbal communication skills
    • Excellent relationship building skills with both internal and external partners with ability to partner with senior leadership
    • Enthusiasm and motivation essential; a confident change-agent; strong selling and presentation skills (oral and written)
    • Willingness to manage and prioritize diverse projects
    • Business and financial acumen in the health care field.
    • Marketing and communications skills are optimal
    • Valid driver's license and reliable transportation with ability and willingness to travel around the region up to 50% of the time.

    Role Desirables

    • Graduate degree preferred
    • Clinical/RN background
    • Knowledge of Humana’s internal policies, procedures and systems
    Additional InformationAt Humana, we know your well-being is important to you, and it’s important to us too. That’s why we’re committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. If you share our passion for helping people, we likely have the right place for you at Humana. After applying, we encourage you to join our Talent Network as well, so you can stay informed and up to date on what’s happening around our organization in the changing world of healthcare.
    Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.
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