Provider Engagement Clinical Executive - Remote FL

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Job Information

Humana

Provider Engagement Clinical Executive - Remote FL

in

Jacksonville

Florida

Description

The Provider Engagement, Clinical Executive 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 Provider Engagement, Clinical Executive works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

The Provider Engagement, Clinical Executive 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.

This work focuses on areas of clinical performance.

Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision

Uses independent judgment requiring analysis of variable factors and determining the best course of action

Leads statewide provider performance evaluations; implements action plans (CAP) and follow up based on outcomes

Leads statewide PCP optimization plan along with network lead- ensures region by region strategy is implemented to allow for improved member engagement and reduced avoidable utilization

Participates in targeted quarterly provider meetings focusing on practice transformation and path to risk providers, driving collaboration with cross functional teams and identifying areas of opportunities to improve member health outcomes and provider financial performance

Required Qualifications

BSN

Unrestricted Registered Nurse License in the state of Florida

Experience in health care or managed care working with provider practices and clinical programs

Established knowledge of reimbursement and bonus methodologies as it relates to value based contracting

Intermediate skills in Microsoft Outlook, Office, Excel, and PowerPoint

Experience planning, preparation, and presentation skills

We will require full COVID vaccination (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html#vaccinated) for this job as 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 or documentation for a medical or religious exemption consideration where allowed by law. Requests for these exemptions should be submitted at least 2 week prior to your scheduled first day of work.

Work At Home Requirements

Must have a separate room with a locked door that can be used as a home office to ensure you and your members have absolute and continuous privacy while you work.

Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.

Travel (see additional Information)

This position is considered 'work at home,' however, you will be required to travel to provider offices within the state with some overnight travel required

Provider facing role

30%-40% travel required

Valid driver's license with reliable transportation and the ability to travel within the state of Florida, as required

This role is 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.

Preferred qualifications:

Master's Degree

Experience with value based operations and identifying areas of opportunity within a provider group

Qualified candidates to reside in Central to North Florida. Jacksonville, Orlando, Tampa Bay

Additional Information

Onsite Travel

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.

#ThriveTogether #WorkAtHome

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Modern Hire Voice 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.

If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed)

inviting you to participate in a Modern Hire Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com