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Humana Gold Plus Integrated is seeking a Provider Engagement, Clinical Executive who will develop and grow positive, long-term relationships with physicians, providers and healthcare systems to support quality performance and improve member outcomes within the contracted working relationship with the health plan. The Provider Engagement, Clinical Executive works on problems of diverse scope and complexity ranging from moderate to substantial. They exercise independent judgment and decision making on complex issues regarding job duties and related tasks and work under minimal supervision. The Provider Engagement, Clinical Executive uses independent judgment requiring analysis of variable factors and determining the best course of action.

The Provider Engagement, Clinical Executive represents the scope of health plan/provider relationship across such areas as, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, and other areas as they relate to provider performance, member experience, market growth, and operational excellence. This work focuses on areas of clinical emphasis and advises executives to develop functional strategies (often segment specific) on matters of significance.

• Oversees plans and implements provider facing Quality Improvement (QI) initiatives, including scorecard development/monitoring, gaps in care reports, and CAHPS survey results/strategy.
• Collaborates with the market provider engagement/contracting/network optimization/practice transformation team to:
• Develops provider engagement strategy, including Value – Based Programs (VBP), high-volume Fee-for-Service (FFS) and dual-eligible when applicable.
• Participates in meetings with providers and network teams (JOC, Clinical/Quality, Operation).
• Develop and/or standardize QI/clinical provider meeting presentations and reporting package.
• Creates market provider quality/clinical performance profiling and develop strategy to assist low performing providers to meet clinical targets.
• Develops EMR interoperability strategy.
• Key contributor to development and oversight of care coordination function (CCF) and outcome reporting.
• Key contributor to market planning sessions on provider risk readiness evaluation and timing.
• Key contributor to quality strategy for all provider facing activities, including participating in integrated care internal workgroups.
• Key contributor to market value-based provider incentive programs, including Primary Care Physician (PCP), specialist, and hospital.
• Department of Health and Family Services (HFS) and Center for Medicaid & Medicaid Services (CMS) point of contact for workgroups to develop provider strategies to improve member outcomes and close gaps.
• Liaison to providers to assist in developing strategies to improve clinical outcomes including but not limited to ER utilization, follow up after hospitalizations and preventive screenings.

Use your skills to make an impact

Required Qualifications

• Candidates must reside within a reasonable distance of Chicago, Illinois, in the states of Illinois, Indiana or Wisconsin.
• Bachelor’s degree.
• Five (5) or more years of experience in clinical strategy and implementation, focused on provider outcomes.
• Knowledge of quality metrics such as HEDIS and NCQA measures.
• Experience in healthcare, payor clinical programs, and value-based care organizations.
• Direct experience working with providers.
• Ability to drive cross functional teams to alignment.
• Demonstrated business and financial acumen.

Preferred Qualifications

• Registered Nurse (RN).
• Five (5) or more years’ experience in clinical practice working with or within a provider organization.
• Knowledge of an integrated care delivery system.
• Experience implementing QI initiatives and strategies.
• Experience using healthcare data and analytics to inform program development.

Additional Information

• Workstyle: This is a remote position with some travel.
• Travel: This role requires up to 10% travel to meet with provider groups within Illinois and occasional onsite meetings at Humana’s Schaumburg, IL office.
• Typical Work Schedule: Monday - Friday; 8:00 AM - 5:00 PM Central Standard Time (CST), with flexibility available.

WAH Internet Statement

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$86,300 - $118,700 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.