The Group Engagement Manager will have responsibility for the establishment, maintenance and oversight of various engaged provider relationships. Engaged providers are certain key strategic physician and hospital providers which have entered into an arrangement with Humana to improve specific clinical, quality, coding and financial metrics, information exchange overall efficiency resulting in improved patient outcomes in the delivery of patient care. These arrangements have various financial mechanisms including, upside only provider incentives, share risk and capitation.
This position will work closely with the engaged providers via regular Joint Operating Committee meetings and ad hoc meetings as needed to provide detailed analysis, reporting, training, education and support to promote provider awareness, processes and infrastructure development to improve clinical, quality, coding and financial performance resulting in increased member value proposition and membership growth. The Manager will coordinate with the engaged providers to understand how to use the tools provided by Humana and will lead the providers in developing action plans to address open issues or improvements.
This position will be the primary liaison between the engaged provider and the various departmental teams and leaders in the Southeast Region including Clinical, Quality, MRA, Finance, Provider Contracting & Support, Sales and Product Development. The Manager will coordinate and facilitate these resources to optimally address all issues relating to the performance of the provider engagement agreement.
Other functions include the below:
Make recommendations to market leadership on product design, contract terms & negotiations, key performance indicators and engagement metrics.
Oversee the reporting functions whether via Service Fund nationally or the local finance and analytic teams.
Manage and deliver reporting and analysis on profitability and performance for internal and external entities on Provider groups
Perform and/or collaborate with Finance on analysis of trend issues, cost savings opportunities, utilization patterns, and other analysis as needed on Provider groups
Make recommendations to market leadership through detailed analysis/consideration of financial and operational implications to Humana and the groups
Serve as focal point for Provider risk group questions regarding financial settlement, delegation, claims adjudication and funding
Successfully facilitate & implement various initiatives with groups (HEDIS, MRA, STARS, etc.)
achelor's degree required; Master's degree preferred
Minimum 5 years in health care or managed care with Provider Contracting, Network Management or Provider Relations experience
Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance
Demonstrated management experience and partnering with senior leadership on strategic initiatives
Comprehensive knowledge of Medicare policies, processes and procedures
Proven planning,preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies
Comprehensive knowledge of all Microsoft Office applications
Expert experience in health care or managed care in lieu of Master's degree preference
This role is a senior level managerial position and reports to the Region President. It will require occasional overnight travel. You will have 3 direct reports in this role.
Work Environment Type
Yes, 10 % of the Time
Humana - 2 years ago
Humana Inc. (Humana) is a full-service benefits solutions company, offering an array of health and supplemental benefit plans for employer...