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+ Clinical Manager, Quality...
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Employer Sponsored Job (Free to apply to)
Humana Inc. Job Title
Clinical Manager, Quality Initiatives/Provider Engagement - Richmond, VA

Company
Humana Inc.

Job Description
Description

The Clinical Manager, Provider Engagement develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve financial and quality performance within the contracted working relationship with the health plan. The Manager, Provider Engagement works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

Responsibilities

The hours are Mon-Fri, 8am-5pm, based from the Richmond office. There is 20% travel to provider locations in VA, MD, DE.

Once proficient in processes and systems, there is flexibility to work at home 1 - 2 days each week as determined by the Quality Director.

This Manager will lead 2 groups: Quality Improvement nurses focused on HEDIS and STAR measures, and provider facing Care Coordinators focused on expense reduction strategies.

The Clinical Manager represents the scope of health plan/provider relationship across such areas as financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, operational improvements and other areas as they relate to provider performance, member experience, market growth, provider experience and operational excellence.

Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.

Required Qualifications

RN Required

Bachelor's Degree

Experience in Population Health, Health care or Managed Care with Provider Contracting, Network Management or Provider Relations experience.

Proven ability supporting quality initiatives and expense reduction

Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies

Demonstrated ability to manage multiple projects and meet deadlines

Comprehensive knowledge of all Microsoft Office applications

Ability to travel as needed

Preferred Qualifications

Nurse Practitioner(NP) strongly preferred

Masters Degree

Understanding of Value Based Contracting / Pay for Performance

Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance

Comprehensive knowledge of Medicare policies, processes and procedures

Additional Information

As part of our hiring process for this opportunity, we will be using a technology called Montage Voice which allows us to quickly connect and gain valuable information from you about your relevant experience.

If you are selected for a phone screen you will receive an email inviting you to participate in a Montage Voice interview. During this call you will be asked a set of questions pertaining to this particular role and you will provide recorded responses. The entire process takes about 15-20 minutes and can be done at your convenience. Your responses will be reviewed and you will be informed if you were selected for an in person or video interview, depending on your location.

Scheduled Weekly Hours

40

About Us

Equal Opportunity Employer

It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.

If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailboxtasrecruit@humana.com for assistance.

Humana Safety and Security

Humana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact mailboxtasrecruit@humana.com to validate the request.


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Location
Richmond, VA



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