Provider Engagement, Clinical Executive

Overview

Become a part of our caring community and help us put health first.

• 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 align engagement strategy.
• 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).
• Develops and/or standardizes QI/clinical provider meeting presentations and reporting package.
• Creates market provider quality/clinical performance profiling and develops 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 work groups.
• Key contributor to market value‑based provider incentive programs, including Primary Care Physician (PCP), specialist, and hospital.
• Act as the point of contact for work groups to develop provider strategies to improve member outcomes and close gaps.
• Liaison to providers to assist in developing strategies to improve clinical outcomes including ER utilization, follow‑up after hospitalizations and preventive screenings.

• 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.

• 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.

Humana, Inc. and its affiliated subsidiaries offer 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.

Humana is committed to providing equal employment opportunities to all employees and applicants. Humana does not 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. 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.