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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in value-based contracting, quality improvement, and provider engagement within the Medicaid landscape. Proven ability to lead teams, analyze performance metrics, and develop strategic initiatives to enhance provider relationships and care quality.
Highest-signal resume keywords
Value-Based Payment ExpertiseQuality Improvement PrinciplesManaged Care Operations ExperienceLeadership and Management SkillsMedicaid Policies Knowledge
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
HEDIS AnalysisFinancial Trend AnalysisQuality Metrics InterpretationProvider Performance ImprovementContract Language UnderstandingClinical Experience in PediatricsBehavioral Health KnowledgeLTSS ExperienceStrategic Initiative DevelopmentProvider Outreach Campaign Execution
Soft Skills
Relationship ManagementTeam BuildingCommunication SkillsCollaborationProblem-Solving
Certifications & Qualifications
Bachelor's DegreeMaster's Degree PreferredClinical Degree PreferredValid State Driver's License
Industry Keywords
Medicaid MCO ContractProvider EngagementQuality Improvement StandardsPerformance ImprovementHealthcare Administration
About the role
Key responsibilities & impact- Oversee a team of associates who build positive, long-term relationships with contracted providers
- Drive high-quality, high-value care for Humana members
- Serve as a content expert in value-based contracting, performance improvement, HEDIS, and quality improvement
- Represent Humana Healthy Horizons in Illinois with providers
- Establish policies and operating procedures for Provider Engagement Associates
- Develop and execute provider outreach campaigns related to quality metrics, quality improvement, and value-based payment models
- Partner with the market Quality team and other internal partners
- Monitor provider feedback and inform improvements to Humana processes
- Monitor team performance against key performance indicators and contractual commitments and requirements
- Work with health plan leadership to improve performance
- Represent local market leadership in planning and strategy with internal corporate partners
- Increase the proportion of the provider network in value-based payment arrangements
- Maintain positive provider relationships and contribute to provider retention in Humana's Medicaid networks
- Onboard and train new provider engagement team members
- Report to the plan's Director, Provider Services
Requirements
What you’ll need- Must reside in the state of Illinois
- Bachelor's degree
- Experience with the Illinois Medicaid MCO contract, including value-based payment and quality improvement standards
- 6 or more years of progressive experience in managed care operations, including value-based payment, provider performance improvement and quality
- Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses, and quality/bonus performance
- Proficiency in quality improvement principles and analyzing quality metrics, such as HEDIS
- Prior experience working in and strong understanding of Medicaid and key provider types, including pediatrics, OB/GYN, and behavioral health
- Exceptional relationship management skills
- Two plus years of demonstrated leadership and management experience and partnering with senior leadership on strategic initiatives
- Comprehensive knowledge of Medicaid policies, processes, and procedures, including managed care contracts, contract language, and reimbursement
- Diverse clinical experience, including working with LTSS and behavioral health providers, OB/GYNs, and pediatricians, to drive performance and quality improvement
- Ability to travel as needed throughout Illinois
- Valid state driver's license
- Personal vehicle liability insurance meeting applicable minimum requirements or the stated coverage limits
- Master's degree preferred
- Clinical degree (e.g., RN, APRN, PA) and/or experience in healthcare administration or quality improvement preferred
- Experience building teams from the ground up in a fast-paced implementation environment preferred
- Home work area must be dedicated and free from ongoing interruptions to protect member PHI/HIPAA information
Benefits
Comp & perks- 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
- Self-provided internet service for home or hybrid home/office work, with required minimum speeds of 25 Mbps download and 10 Mbps upload
- Remote work with occasional travel to Humana offices for training or meetings