Description The Senior Provider Engagement Professional 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 Senior Provider Engagement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Responsibilities The Senior Provider Engagement Professional 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. Promote Medicare Risk Adjustment prospective tools and works on implementation. Begins to influence departments strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. Performs provider service function to include answering questions about claims and authorizations and other inquiries Required Qualifications Bachelor's Degree 5 or more years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience Experience with HEDIS and CMS Stars Measures as well as Medicare Risk Adjustment operations Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies Demonstrated ability to manage multiple projects and meet deadlines Must be passionate about contributing to an organization focused on continuously improving consumer experiences Must be fluent in English and Mandarin (Reading, Writing, Speaking) Preferred Qualifications Master's Degree 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 This position is considered \"work at home\" however, you must live within the NYC region as you will be required to travel daily within the five burrows of New York City. Scheduled Weekly Hours 40
Birmingham, AL, USA
Description The Consumer Engagement Professional 2 oversees the enrollment, education, engagement, and activation duties for client groups regardless of segment, and for product where warranted. The Consumer Engagement Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Responsibilities The Consumer Engagement Professional 2 contributes to business strategy by understanding benefit offerings to ensure enrollment success, identifying member education opportunities to drive maximum utilization of available resources, and directing clients on the use of available resources. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Required Qualifications + Bachelor's degree in Business or related field or comparable experience and background + Effective communication and presentation skills + Solid personal accountability and able to work independently + Health and Life license or in process of pursuing (completion within 60 days of hire) + This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits. + Able to travel throughout AL 70% of the time + Comprehensive knowledge of Microsoft Word, Excel and PowerPoint + Able to meet deadlines, work with minimum supervision Preferred Qualifications + Previous project management experience + Previous experience in sales and account management + Bilingual English/Spanish Additional Information + This role is Work at Home and the travel requirements are throughout Alabama Scheduled Weekly Hours 40 About Us Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms -when and where they need it. Our employees are at the heart of making this happen and that's why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first. 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 ...@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 ...@humana.com to validate the request.
Louisville, KY, USA
Description The Senior Software Engineer codes software applications based on business requirements. The Senior Software Engineer work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Responsibilities The Senior Software Engineer standardizes the quality assurance procedure for software. Oversees testing and debugging and develops fixes. Researches complaints and makes necessary adjustments and/or recommendations to resolve complex software related issues. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. Required Qualifications Bachelor's Degree in Computer Science or related field Five years of experience designing, developing, and testing of software applications and/or infrastructure .Net / C# Web API 2.0 Web Services WCF Working with MVC pattern SQL Server Informatica 10 Azure cloud practices SSIS / SSRS (recommended) Preferred Qualifications Master's Degree Additional Information Scheduled Weekly Hours 40 - provided by Dice
Required Qualifications Active RN license in the state(s) in which the nurse is required to practice Must live within the Mountain or Pacific Time zones At least 3 years of varied clinical nursing experience Proficient with Microsoft Office products including Word, Excel and Outlook Ability to work independently under general instructions and with a team Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required Ability to provide a designated workspace; free from distractions with the ability to secure any protected information. Preferred Qualifications 3-5 years of prior utilization management experience Education: BSN or Bachelor's degree in a related field Health Plan experience Previous Medicare/Medicaid Experience a plus Call center or triage experience Bilingual is a plus Additional Information Associated topics: asn, bsn, cardiothoracic, care unit, coronary, infusion, neonatal, nurse, nurse rn, tcu