Senior Provider Engagement Clinical Professional

Profile

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

BSN or Associate Degree in Nursing

Nursing license unrestricted in the state of Tennessee

5 years of experience working as a registered nurse

Excellent Communication skills

Excellent Organizational Skills

Well versed in Microsoft office, Excel and PowerPoint

Preferred Qualifications

3-5 years of managed care experience

3-5 years of case management experience

HEDIS knowledge

Experience with Medicare STARs program

Additional Information

This position is considered remote/work at home, however, you must live within the region which includes Tennessee or Alabama.

Work at Home/Remote Requirements Must ensure designated work area is free from distractions during work hours and virtual meetings Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required

Scheduled Weekly Hours

40

Company info

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