Director of Provider Engagement
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Job Description
Director leading provider engagement for Humana’s Medicare Advantage network. Managing teams, provider relationships, value-based care, quality outcomes, and Star Ratings performance.
Responsibilities:
- Lead a team of Provider Engagement associates responsible for relationships with contracted physicians, provider groups, health systems, and ancillary providers
- Develop and strengthen positive, long-term provider relationships across Humana's Medicare Advantage network
- Drive provider engagement strategies focused on provider experience, quality outcomes, Star Ratings performance, value-based care adoption, risk adjustment performance, and operational excellence
- Report to the VP, Network Performance
- Serve as a key market leader representing Provider Engagement across cross-functional initiatives
- Ensure alignment between provider needs and Humana's strategic priorities
- Establish team strategy, operating processes, and performance expectations
- Conduct performance evaluations and provide coaching, mentoring, and professional development
- Foster accountability, collaboration, continuous improvement, and provider-centric engagement
- Monitor performance against KPIs and organizational goals
- Build and sustain relationships with value-based provider partners
- Represent Humana at provider meetings, association events, market forums, and strategic provider discussions
- Develop and execute strategies supporting Medicare Star Ratings improvement and quality objectives
- Partner with provider organizations on value-based payment arrangements and alternative payment models
- Use claims, quality, risk adjustment, utilization, and provider performance data to identify trends, barriers, and opportunities
- Provide leadership visibility into provider trends, risks, barriers, and opportunities affecting market performance
- Track and report provider engagement activities, strategic initiatives, and performance results
- Travel occasionally to Humana offices for training or meetings
Requirements:
- 7+ years of experience in managed care, provider relations, healthcare operations, quality improvement, value-based care, or related healthcare leadership roles
- 5+ years of people leadership experience, including leading teams and developing talent
- Experience working with provider groups, health systems, and healthcare organizations
- Knowledge of Medicare Advantage operations, provider performance management, and healthcare delivery systems
- Comprehensive knowledge of CMS Star Ratings, HEDIS, CAHPS, and risk adjustment
- Experience using data and analytics to identify performance opportunities and influence operational outcomes
- Experience presenting to leadership
- Experience with Excel and PowerPoint
- Ability to travel 25% within assigned market geography
- Degree in Healthcare Administration, Business Administration, Public Health, or related field (preferred)
- Knowledge of Medicaid regulatory requirements (preferred)
- Demonstrated strategic planning and project execution capabilities (preferred)
- Ability to work from a dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information
- Self-provided internet service with minimum download speed of 25 Mbps and upload speed of 10 Mbps
Benefits:
- Bonus incentive plan based upon company and/or individual performance
- Medical benefits
- Dental benefits
- Vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company holidays
- Personal holidays
- Paid parental leave
- Paid caregiver leave
- Short-term disability
- Long-term disability
- Life insurance
- Home or Hybrid Home/Office work arrangement
- Professional development opportunities
- Dedicated home workspace to protect member PHI/HIPAA information
- Internet service requirements/support for home or hybrid employees
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