Associate Director, Provider Engagement

Associate Director, Provider Engagement

Become a part of our caring community The Associate Director, Provider Engagement oversees a team of associates that grow positive, long-term relationships with contracted providers in order to drive high quality, high value care for Humana members. The Associate Director is a content expert in value-based contracting, performance improvement, and HEDIS and quality improvement. This individual represents Humana Healthy Horizons in Illinois with providers, establishes policies and operating procedures for Provider Engagement Associates, promotes associate development, and monitors team performance against key performance indicators or contractual requirements.

This is a collaborative role requiring critical thinking and problem-solving skills, independence, leadership, a strategic mindset, and attention to detail. This position reports to the plan's Director, Provider Services.

• Establish policies and operating procedures for team of provider engagement representatives
• Guide engagement strategy to support and encourage high performance in key adult and child quality measures and Humana's value-based payment arrangements, closure of care gaps, and participation in Humana's quality improvement and compliance initiatives
• Develop and execute on provider outreach campaigns related to quality metrics, quality improvement, and value-based payment models, in partnership with the market Quality team and other internal partners
• Monitor all feedback from individual providers to inform improvements to Humana processes
• Monitor team's performance against key performance indicators and contractual commitments and requirements. Work with health plan leadership to improve performance, as needed
• Represent the local market leadership in planning and strategy with internal corporate partners to ensure cross-department alignment and communication
• Work with internal corporate partners to increase proportion of provider network in value-based payment arrangements
• Ensure positive provider relationships and contribute to provider retention in Humana's Medicaid networks
• Onboard and train new provider engagement team members
• Use your skills to make an impact

• Must reside in the state of Illinois.
• Bachelor's degree
• Experience with the Illinois Medicaid MCO contract, including value-based payment and quality improvement standards.
• 6 or more years of progressive experience in managed care operations, including value-based payment, provider performance improvement and quality
• Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses, and quality/bonus performance
• Proficiency in quality improvement principles and analyzing quality metrics, such as HEDIS, to drive higher performance
• Prior experience working in and strong understanding of Medicaid and Medicaid key provider types, including pediatrics, OB/GYN, and behavioral health
• Exceptional relationship management skills
• Two plus years of demonstrated leadership and management experience and partnering with senior leadership on strategic initiatives
• Comprehensive knowledge of Medicaid policies, processes, and procedures, including thorough understanding of managed care contracts (e.g., contract language and reimbursement)
• Diverse clinical experience, including experience working with LTSS and behavioral health providers, OB/GYNs, and pediatricians, to drive performance and quality improvement
• Ability to travel as needed throughout Illinois

• Master's Degree Clinical Degree (e.g., RN, APRN, PA) and/or experience working in a healthcare administration or quality improvement setting
• Experience with the Illinois Medicaid MCO contract, including and standards for value-based payment and quality improvement.
• Experience building teams from the ground up in a fast-paced implementation environment

This role is part of Humana's driver safety program and therefore requires an individual to have a valid state's driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in…