Become a part of our caring community and help us put health first
 

The Residential Provider Engagement Professional 2 develops and grows positive, long-term relationships with Residential providers in order to support our providers and members in Residential settings. and improve financial and quality performance within the contracted working relationship with the health plan. The Residential Provider Engagement Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. This position works with the member's team on finding Residential placement.

• Sustain positive relationships with external and internal stakeholders demonstrating excellent customer service.
• Works collaboratively with stakeholders, members, guardians, providers, and others to implement innovative and cost-effective managed care models/approaches.
• Develops a robust network that supports member choice, increases community connections, which supports dignity and fosters full participation in communities.
• Monitors and ensures contracted provider compliance with federal, state, and contract requirements and adherences to policies and procedures and other regulations.
• Participates in the development and implementation of innovative policies and procedures related to provider contracting, rate setting, and contract compliance.
• Negotiates rates with providers.
• Support network of providers to ensure quality and compliance of family care regulations.
• Educates providers and other stakeholders on contract compliance.
• Works collaboratively with Quality Department in quality activities related to contracted providers.
• Act as an active member to find viable residential options to meet member’s unique needs and outcomes, providing recommendations to the team and members.
• Coordinates and attends meetings with providers in the network and external stakeholders for educational and performance standards purposes, including provider service expectations and/or quality concerns.
• Some travel as needed for provider quality support and follow-up - travel in/around Superior, Ladysmith, Ashland areas.

Use your skills to make an impact
 

Required Qualifications

• Bachelor's Degree
• 1 - 5 years of Provider Relations or Managed Care experience

Preferred Qualifications

• Proficiency in analyzing and interpreting financial trends for health care costs, work through budget planning and assess quality performance
• Comprehensive knowledge of Medicare policies, processes and procedures
• Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies
• Demonstrated ability to manage multiple projects and meet deadlines
• Strong communication skills including written and verbal
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Additional Information

• Workstyle: Hybrid Home
• Work Location: Wisconsin
• Travel: up to 20% travel in WI region
• Typical Work Days/Hours: Monday through Friday, 8:00 am – 4:30 pm CST.

WAH Internet Statement

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Benefits

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

• Health benefits effective day 1
• Paid time off, holidays, volunteer time and jury duty pay
• Recognition pay
• 401(k) retirement savings plan with employer match
• Tuition assistance
• Scholarships for eligible dependents
• Parental and car