NY Staffing
Provider Support Model Lead, Provider Engagement
NY Staffing, Providence, Rhode Island, United States, 02912
Provider Support Model Lead
Become a part of our caring community and help us put health first. Humana Healthy Horizons is seeking a Provider Support Model Lead, Provider Engagement to support new Medicaid markets in standing up the Provider Engagement functions, including people, processes, and tools, in alignment with Medicaid segment standards and contractual requirements. This role is responsible for creating and maintaining segment best practices on Provider Engagement staffing, processes, tools to support PCPs, pediatricians, as well as specialty providers (e.g, BH, LTSS) in improving their quality and VBP performance. The Provider Support Model Lead partners cross-functionally on matters of significance to ensure we deliver best-in-class provider experiences and are compliant with related contractual requirements. This role is responsible for creation of and implementation of process and solutions for both standard and non-standard contract requirements, and/or resolving complex technical and operational challenges. As a result, this Lead position requires a solid understanding of how organization capabilities interrelate across department(s). Provider Support Model Lead Key Role Objectives include: Segment Best Practices Lead Humana provider engagement strategy to drive optimal provider experience and performance in alignment with organizational goals and industry trends. Maintain and enhance our Medicaid Provider Support Model to create standardized and scalable processes, resources, and tools (80% repeatable staffing, processes, technology) related to Provider Engagement functions. Develop resources for market Provider Engagement staff to use in supporting PCPs, pediatricians, OB/GYNs, BH, and LTSS providers in VBP arrangements. Partner closely with Medicaid VBP team to ensure resources align with goals of core VBP models. Lead development of practice transformation strategy/program that markets can adopt. Design new innovations and solutions to ensure our Medicaid Provider Support Model is industry competitive and drives positive outcomes and make available for new market rollout. Consult with active markets on strategies for improving provider performance and VBP engagement, as appropriate. Improve segment/80% standard operating procedures over time to drive efficiencies and repeatable processes for new market implementations. New Market Implementation Responsible for effective and timely implementation of provider engagement business functions in new Medicaid markets, including but not limited to local market provider engagement department staffing and standard operating procedure development, tools and provider visit documentation, and development and execution of Provider Engagement plan. Lead creation of and maintenance of the Provider Support Model implementation handbook specific to Provider Engagement. Responsible to create processes and materials to stand up Provider Engagement teams and processes in Medicaid markets. Some examples below: Assist with creation of resources for providers to meet identified cost and quality improvement opportunities Develop processes for the market to monitor and support VBP performance for applicable providers Develop processes for the market to assess provider value-based maturity and identify opportunities to advance along the VBP continuum Develop process for market to evaluate and approve any non-standard VBP terms requested by providers Assist new markets in identifying providers to participate in Year 1 VBP models Assist new markets in identifying primary care providers who need access to Compass, identify which providers need BAAs, and work with Medicaid VBP to establish access. Assist with interviewing and hiring of new market Provider Engagement staff and department leadership and serve as a mentor during the implementation period. Assist market in training of staff on market tools, such as QuickBase and Compass, available reporting, Joint Operating Committees, and market processes. Use your skills to make an impact Required Qualifications 5+ years of experience with Provider Engagement, Quality, and/or value based performance improvement, at least two of which are working for a health plan. 5+ years HEDIS and quality measures and ability to review and interpret cost and quality data to drive improvements. Experience working with Medicaid providers and/or Medicaid health plans. Experience in driving decisions on complex issues. Proven expertise in driving operational efficiencies and management of timelines and processes. Highly adept at managing processes from concept to completion ensuring on-time, on-budget, and on-target results. Intermediate to Advanced using MS Office, utilizing multiple shared systems, platforms, and being able to troubleshoot and resolve general technical issues. Must work independently, prioritizing work with exceptional time management and ability to manage multiple priorities in a fast-paced environment. Preferred Qualifications Bachelor's of Master's degree. Experience with standing-up new health plan operations and/or implementations. Experience working with BH providers, LTSS providers, and/or hospitals in value based performance or performance improvement. Passionate about contributing to an organization focused on continuously improving provider experiences. Additional Information Workstyle: Remote work at home Location: U.S. Core Workdays & Hours: Typically, 8-5 pm Monday
Friday; Eastern Standard Time (EST) Travel: None, except for annual meeting at a Humana office location. Work at Home Guidance 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 required; 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. Interview Format As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews. SSN Alert Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana's secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $94,900 - $130,500 per year. This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time
Become a part of our caring community and help us put health first. Humana Healthy Horizons is seeking a Provider Support Model Lead, Provider Engagement to support new Medicaid markets in standing up the Provider Engagement functions, including people, processes, and tools, in alignment with Medicaid segment standards and contractual requirements. This role is responsible for creating and maintaining segment best practices on Provider Engagement staffing, processes, tools to support PCPs, pediatricians, as well as specialty providers (e.g, BH, LTSS) in improving their quality and VBP performance. The Provider Support Model Lead partners cross-functionally on matters of significance to ensure we deliver best-in-class provider experiences and are compliant with related contractual requirements. This role is responsible for creation of and implementation of process and solutions for both standard and non-standard contract requirements, and/or resolving complex technical and operational challenges. As a result, this Lead position requires a solid understanding of how organization capabilities interrelate across department(s). Provider Support Model Lead Key Role Objectives include: Segment Best Practices Lead Humana provider engagement strategy to drive optimal provider experience and performance in alignment with organizational goals and industry trends. Maintain and enhance our Medicaid Provider Support Model to create standardized and scalable processes, resources, and tools (80% repeatable staffing, processes, technology) related to Provider Engagement functions. Develop resources for market Provider Engagement staff to use in supporting PCPs, pediatricians, OB/GYNs, BH, and LTSS providers in VBP arrangements. Partner closely with Medicaid VBP team to ensure resources align with goals of core VBP models. Lead development of practice transformation strategy/program that markets can adopt. Design new innovations and solutions to ensure our Medicaid Provider Support Model is industry competitive and drives positive outcomes and make available for new market rollout. Consult with active markets on strategies for improving provider performance and VBP engagement, as appropriate. Improve segment/80% standard operating procedures over time to drive efficiencies and repeatable processes for new market implementations. New Market Implementation Responsible for effective and timely implementation of provider engagement business functions in new Medicaid markets, including but not limited to local market provider engagement department staffing and standard operating procedure development, tools and provider visit documentation, and development and execution of Provider Engagement plan. Lead creation of and maintenance of the Provider Support Model implementation handbook specific to Provider Engagement. Responsible to create processes and materials to stand up Provider Engagement teams and processes in Medicaid markets. Some examples below: Assist with creation of resources for providers to meet identified cost and quality improvement opportunities Develop processes for the market to monitor and support VBP performance for applicable providers Develop processes for the market to assess provider value-based maturity and identify opportunities to advance along the VBP continuum Develop process for market to evaluate and approve any non-standard VBP terms requested by providers Assist new markets in identifying providers to participate in Year 1 VBP models Assist new markets in identifying primary care providers who need access to Compass, identify which providers need BAAs, and work with Medicaid VBP to establish access. Assist with interviewing and hiring of new market Provider Engagement staff and department leadership and serve as a mentor during the implementation period. Assist market in training of staff on market tools, such as QuickBase and Compass, available reporting, Joint Operating Committees, and market processes. Use your skills to make an impact Required Qualifications 5+ years of experience with Provider Engagement, Quality, and/or value based performance improvement, at least two of which are working for a health plan. 5+ years HEDIS and quality measures and ability to review and interpret cost and quality data to drive improvements. Experience working with Medicaid providers and/or Medicaid health plans. Experience in driving decisions on complex issues. Proven expertise in driving operational efficiencies and management of timelines and processes. Highly adept at managing processes from concept to completion ensuring on-time, on-budget, and on-target results. Intermediate to Advanced using MS Office, utilizing multiple shared systems, platforms, and being able to troubleshoot and resolve general technical issues. Must work independently, prioritizing work with exceptional time management and ability to manage multiple priorities in a fast-paced environment. Preferred Qualifications Bachelor's of Master's degree. Experience with standing-up new health plan operations and/or implementations. Experience working with BH providers, LTSS providers, and/or hospitals in value based performance or performance improvement. Passionate about contributing to an organization focused on continuously improving provider experiences. Additional Information Workstyle: Remote work at home Location: U.S. Core Workdays & Hours: Typically, 8-5 pm Monday
Friday; Eastern Standard Time (EST) Travel: None, except for annual meeting at a Humana office location. Work at Home Guidance 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 required; 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. Interview Format As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews. SSN Alert Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana's secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $94,900 - $130,500 per year. This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time