Humana · 1 month ago
Provider Engagement, Clinical Executive
Gary, IN
Full-time
Hybrid
Mid, Senior Level
$86K/yr - $119K/yr
5+ years expHumana is committed to putting health first and is seeking a Provider Engagement, Clinical Executive to develop and grow relationships with healthcare providers. This role focuses on improving quality performance and member outcomes through strategic clinical initiatives and collaboration with various teams.
Health CareHealth InsuranceInsuranceVenture Capital
Responsibilities
Oversees plans and implements provider facing Quality Improvement (QI) initiatives, including scorecard development/monitoring, gaps in care reports, and CAHPS survey results/strategy
Collaborates with the market provider engagement/contracting/network optimization/practice transformation team to: Develops provider engagement strategy, including Value – Based Programs (VBP), high-volume Fee-for-Service (FFS) and dual-eligible when applicable
Participates in meetings with providers and network teams (JOC, Clinical/Quality, Operation)
Develop and/or standardize QI/clinical provider meeting presentations and reporting package
Creates market provider quality/clinical performance profiling and develop strategy to assist low performing providers to meet clinical targets
Develops EMR interoperability strategy
Key contributor to development and oversight of care coordination function (CCF) and outcome reporting
Key contributor to market planning sessions on provider risk readiness evaluation and timing
Key contributor to quality strategy for all provider facing activities, including participating in integrated care internal workgroups
Key contributor to market value-based provider incentive programs, including Primary Care Physician (PCP), specialist, and hospital
Department of Health and Family Services (HFS) and Center for Medicaid & Medicaid Services (CMS) point of contact for workgroups to develop provider strategies to improve member outcomes and close gaps
Liaison to providers to assist in developing strategies to improve clinical outcomes including but not limited to ER utilization, follow up after hospitalizations and preventive screenings
Qualification
Required
Candidates must reside within a reasonable distance of Chicago, Illinois, in the states of Illinois, Indiana or Wisconsin
Bachelor's degree
Five (5) or more years of experience in clinical strategy and implementation, focused on provider outcomes
Knowledge of quality metrics such as HEDIS and NCQA measures
Experience in healthcare, payor clinical programs, and value-based care organizations
Direct experience working with providers
Ability to drive cross functional teams to alignment
Demonstrated business and financial acumen
Preferred
Registered Nurse (RN)
Five (5) or more years' experience in clinical practice working with or within a provider organization
Knowledge of an integrated care delivery system
Experience implementing QI initiatives and strategies
Experience using healthcare data and analytics to inform program development
Benefits
Medical, dental and vision benefits
401(k) retirement savings plan
Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
Short-term and long-term disability
Life insurance
Company
Humana
Humana is a health insurance provider for individuals, families, and businesses.
10001+ employees
H1B Sponsorship
Humana has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (282)
2024 (246)
2023 (284)
2022 (274)
2021 (212)
2020 (84)
Funding
Current Stage
Public CompanyTotal Funding
$13.07B2025-05-30Post Ipo Debt· $5B
2025-03-03Post Ipo Debt· $1.25B
2024-03-11Post Ipo Debt· $2.25B
Leadership Team
Jim Rechtin
CEO and President
Caleb Gallifant
Chief Operating Officer, CenterWell Home Health
Recent News
2026-01-16
2026-01-16
Company data provided by crunchbase