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Humana Senior Provider Engagement, Clinical Professional in Birmingham, Alabama

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

  • Bachelors or Associates Degree in Nursing

  • Registered Nurse license unrestricted in the state of Tennessee, Alabama or Virginia

  • 5+ years clinical work experience as an RN

  • Excellent communication and organizational skills

  • Ability to work independently

  • Self-motivated

  • Working knowledge of Microsoft Office: Word, Excel, PowerPoint

Preferred Qualifications

  • 3-5 years of managed care experience

  • 3-5 years of case management experience

  • Knowledge of HEDIS measures

  • Experience with CMS Medicare Advantage Star Ratings program

Additional Information

  • This position is virtual and work at home

  • Must be comfortable communicating virtually with providers and members

  • Ideal candidate will reside in Tennessee, Alabama or southwest Virginia and have the ability to travel to Knoxville, TN for mandatory meetings

Scheduled Weekly Hours

40

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