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Provider Engagement Executive
Humana. Represent health plan/provider relationships across financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, and operational improvements .
Posted 10/8/2026full-timeRemote • Virginia • United StatesSeniorLead💰 $86,300 - $118,700 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive experience in Provider Engagement and Value-Based Programs, with a strong focus on quality improvement and performance metrics analysis. Proficient in managing provider relationships and ensuring compliance with Medicaid/Medicare policies while delivering impactful presentations.
Highest-signal resume keywords
Provider EngagementValue-Based ProgramsHEDIS PerformanceProject ManagementFinancial Trend Analysis
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Quality ImprovementPerformance Metrics AnalysisData SharingClinical ManagementPopulation HealthDocumentation and CodingIncentive ProgramsProvider RelationsManaged CareMedicaid/Medicare Policies
Soft Skills
CollaborationCommunicationRelationship ManagementProblem SolvingPresentation Skills
Tools & Technologies
Microsoft OfficeExcelPowerPointOutlookWord
Industry Keywords
Health CareManaged CareValue-Based PaymentHEDISSTARs PerformanceProvider Support OrganizationJoint Operating CommitteeComplianceUtilization PatternsClinical Education
About the role
Key responsibilities & impact- Represent health plan/provider relationships across financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, and operational improvements
- Develop and maintain positive provider relationships to optimize provider experience and satisfaction related to quality improvement and value-based payment performance
- Coordinate quality and value-based payment data with providers and internal corporate partners
- Collaborate with providers to identify population and individual health needs for tailored interventions
- Gather and analyze provider performance reports, HEDIS measures, enrollee feedback, utilization patterns, clinical trend measures and other performance metrics
- Implement strategies to improve provider performance and quality-improvement best practices
- Convene Joint Operating Committee and other provider meetings representing the provider support organization
- Ensure compliance with state Managed Care Contractual requirements for provider quality improvement and value-based payment arrangements
- Monitor provider feedback to inform improvements to Humana processes
- Manage the provider continuum and prospect providers for value-based opportunities
- Facilitate clinical education and utilization interventions
- Report to the Director, Provider Engagement
Requirements
What you’ll need- 8+ years of experience in health care or managed care with Provider Engagement, Value-Based programs, Provider Relations, or Quality/HEDIS
- 2+ years of demonstrated project management experience and managing multiple programs
- Experience planning, preparing, and delivering presentations
- Proficiency in analyzing financial trends for health care costs, administrative expenses and quality/bonus performance
- Comprehensive knowledge of all Microsoft Office applications (Outlook, Excel, Word, PowerPoint)
- Must live in Virginia
- Travel up to 25% within the state of Virginia
- Comprehensive knowledge of Medicaid/Medicare policies, processes and procedures preferred
- Bachelor's degree preferred
- Minimum home internet speed of 25 Mbps download and 10 Mbps upload
- Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information
Benefits
Comp & perks- Bonus incentive plan based on 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
- Remote work arrangement
- Use of Humana office space on an as-needed basis
- Dedicated home workspace and internet requirements supporting remote work