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Humana
Humana
H1B Visa SponsorHealthcareHealthcare InsuranceInsurance
Humana is a healthcare and health insurance company focused on improving health outcomes for individuals, communities, and the broader healthcare system. Its work includes Medicare Advantage HMO, PPO, and PFFS plans serving populations such as seniors and military members. Humana also emphasizes an inclusive workplace built around belonging, mutual respect, and opportunities for employees to contribute to the company’s health-focused mission.
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Provider Engagement Executive – Virginia (Remote)

Lead provider relationships and value-based care performance for Humana’s Virginia health plan. Analyze HEDIS, quality, utilization, and financial data to improve outcomes and provider performance.

USUnited StatesVAVirginia
$86,300 – $118,700 / year
RemoteFull-timeSeniorLeadEnglish RequiredExecutive

Description

  • Manage health plan and provider relationships spanning financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs results, and operational improvement.
  • Build and sustain provider partnerships that strengthen provider experience and satisfaction while advancing quality improvement and value-based payment performance.
  • Coordinate quality and value-based payment data among providers and internal corporate teams.
  • Work with providers to identify population-level and individual health needs and develop tailored interventions.
  • Collect and evaluate provider performance reports, HEDIS measures, enrollee feedback, utilization patterns, clinical trends, and other performance indicators.
  • Execute strategies that enhance provider performance and promote quality-improvement best practices.
  • Lead Joint Operating Committee sessions and other provider meetings on behalf of the provider support organization.
  • Maintain compliance with state Managed Care Contractual requirements governing provider quality improvement and value-based payment arrangements.
  • Use provider feedback to guide improvements to Humana processes.
  • Oversee the provider continuum and identify prospective providers for value-based opportunities.
  • Coordinate clinical education and utilization-focused interventions.
  • Report to the Director of Provider Engagement.

Requirements

  • At least 8 years of health care or managed care experience in Provider Engagement, value-based programs, Provider Relations, or Quality/HEDIS.
  • At least 2 years of demonstrated project management experience overseeing multiple programs.
  • Experience planning, preparing, and delivering presentations.
  • Ability to analyze financial trends in health care costs, administrative expenses, and quality or bonus performance.
  • Comprehensive knowledge of Microsoft Office applications, including Outlook, Excel, Word, and PowerPoint.
  • Must reside in Virginia.
  • Willingness to travel up to 25% within Virginia.
  • Comprehensive knowledge of Medicaid and Medicare policies, processes, and procedures preferred.
  • Bachelor’s degree preferred.
  • Home internet service with minimum speeds of 25 Mbps download and 10 Mbps upload.
  • Dedicated workspace with no ongoing interruptions to safeguard member PHI and HIPAA information.

Benefits

  • Bonus incentive plan tied to 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 coverage.
  • Long-term disability coverage.
  • Life insurance.
  • Remote work arrangement.
  • Access to Humana office space as needed.
  • Dedicated home workspace and internet requirements that support remote work.

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