Senior Provider Engagement Clinical Professional - Remote MO

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Job Information

Humana

Senior Provider Engagement, Clinical Professional - Remote, MO

in

Springfield

Missouri

Description

The Senior Provider Engagement, Clinical 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, Clinical 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, Clinical 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. This work focuses on areas of clinical emphasis. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, andwork is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Required Qualifications

Must have an active LPN or RN license in MO with no restrictions

5-6 years of varied clinical nursing experience

Background analyzing data and working with reports

Strong team player and the ability to network effectively with other business groups

Strong communication skills both verbal and written

Strong presentation skills in virtual and in person environment

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Ability to work independently under general instructions

Proficient with Microsoft Office products including Word, Excel and Outlook

This position requires you to have a valid driver's license and 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 (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

Ability to provide a designated workspace; free from distractions with the ability to secure any protected information

Must live within a commutable distance from St. Louis, MO area to visit provider groups on a weekly basis

Preferred Qualifications

Bachelor's degree in Nursing, Business or Finance

Prefer Clinical experience to be Critical Care, ER, LTACH or HH

Plus to have Six Sigma

Background working with HEDIS and Stars measures

Experience working in a primary care physician (PCP) office

Previous insurance experience

Previous UM or CM in acute facility or insurance environment

Experience with multiple EMRs, Platforms such as Tableau or PowerBI

Additional Information

30% travel will be required locally within the state

This role is part of Humana's Driver Safety and Vehicle Management Program. Since this role will require driving for the Company, at least part of the time, you may be subject to continuous Motor Vehicle Record (MVR) monitoring and required to complete Humana's initial online driver's training.

This position is also eligible for mileage reimbursement for personal vehicles and to be covered

after

the first stop of the day and

before

the last stop of the day. Initial mileage to and from your home is not covered with exceptions for business travel incurred over and above the standard commute. Please ask your recruiter for additional details.

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

Company info

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