Humana
Sr. Provider Engagement Professional
Humana is looking for a Sr. Provider Engagement Professional to manage operational processes, compliance activities, and provider engagement for the DSNP plans. The role ensures accurate program tracking, supports payer relationships, facilitates training and communication across internal and external stakeholders, and maintains positive long‑term relationships with brokers, healthcare systems, state government, community‑based organizations, and other health plans in the Intermountain Region.
Base Pay Range $71,100 - $97,800 per year
Responsibilities
Provide end‑to‑end oversight of the DSNP Health Home program, ensuring smooth operations and compliance.
Track program activity, maintain accurate policies and procedures, and support payer partnerships through meeting coordination and presentation development.
Lead training efforts for internal teams and external stakeholders.
Collaborate with partners to resolve plan issues and support member communications.
Manage system access for state platforms, oversee compliance projects, and ensure timely updates to provider manuals and websites.
Maintain contact lists, handle data files, and provide backup support for program communications.
Support expectations in the 2026 and future SMACs, including issuing required notices to long‑term services and supports when criteria are met, and coordinate support with complex hospital discharge cases.
Perform additional duties as assigned.
Required Qualifications
Bachelor’s degree, preferably in healthcare administration, public health, health informatics, social services, nursing, business administration or a related field.
3+ years of experience in managed care, DSNP programs, health home operations, network management, provider relations, or work with state health agencies/community organizations.
In‑depth knowledge of CMS and state regulations for DSNP, Medicare/Medicaid, and related programs.
Strong organizational and communication skills with the ability to manage diverse stakeholders.
Proficiency in planning, preparation, and delivering presentations, managing multiple projects and meeting deadlines with attention to detail.
Proficiency in healthcare systems and Microsoft Office Suite.
Passion for continuously improving consumer experiences.
Preferred Qualifications
Master’s degree in a healthcare‑related field.
Experience with project management tools and methodologies.
Advanced knowledge of CMS compliance audits and state regulatory processes.
Familiarity with payer relations and contract management.
Strong data analysis and reporting skills for program performance metrics.
Experience developing training programs and leading stakeholder education sessions.
Demonstrated ability to lead cross‑functional teams and drive process improvements.
Additional Information Work From Home / Internet Statement:
Home or hybrid employees must provide a self‑provided internet service that meets a minimum download speed of 25 Mbps and an upload speed of 10 Mbps; wireless, wired, cable or DSL connections are suggested. Satellite, cellular and microwave connections may be used only if approved by leadership. Employees who live and work from home in California, Illinois, Montana or South Dakota will receive a bi‑weekly payment for their internet expense. Humana will provide telephone equipment appropriate for business requirements. Employees must work from a dedicated space that protects member PHI/HIPAA information.
Travel:
Occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours:
40
Pay Range:
$71,100 - $97,800 per year This job is eligible for a bonus incentive plan based upon company and/or individual performance.
Description of Benefits Humana, Inc. and its affiliated subsidiaries offer competitive benefits that support whole‑person well‑being, including medical, dental and vision, 401(k) retirement savings plan, time off, short‑term and long‑term disability, life insurance and many other opportunities.
Application Deadline 01‑09‑2026
About Humana Humana Inc. (NYSE: HUM) is committed to putting health first for teammates, customers and the company. Through our Humana insurance services and CenterWell healthcare services, we enable millions of people to achieve their best health.
Equal Opportunity Employer Humana does not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. Humana also takes affirmative action to employ and advance individuals with disability or protected veteran status.
#J-18808-Ljbffr
Base Pay Range $71,100 - $97,800 per year
Responsibilities
Provide end‑to‑end oversight of the DSNP Health Home program, ensuring smooth operations and compliance.
Track program activity, maintain accurate policies and procedures, and support payer partnerships through meeting coordination and presentation development.
Lead training efforts for internal teams and external stakeholders.
Collaborate with partners to resolve plan issues and support member communications.
Manage system access for state platforms, oversee compliance projects, and ensure timely updates to provider manuals and websites.
Maintain contact lists, handle data files, and provide backup support for program communications.
Support expectations in the 2026 and future SMACs, including issuing required notices to long‑term services and supports when criteria are met, and coordinate support with complex hospital discharge cases.
Perform additional duties as assigned.
Required Qualifications
Bachelor’s degree, preferably in healthcare administration, public health, health informatics, social services, nursing, business administration or a related field.
3+ years of experience in managed care, DSNP programs, health home operations, network management, provider relations, or work with state health agencies/community organizations.
In‑depth knowledge of CMS and state regulations for DSNP, Medicare/Medicaid, and related programs.
Strong organizational and communication skills with the ability to manage diverse stakeholders.
Proficiency in planning, preparation, and delivering presentations, managing multiple projects and meeting deadlines with attention to detail.
Proficiency in healthcare systems and Microsoft Office Suite.
Passion for continuously improving consumer experiences.
Preferred Qualifications
Master’s degree in a healthcare‑related field.
Experience with project management tools and methodologies.
Advanced knowledge of CMS compliance audits and state regulatory processes.
Familiarity with payer relations and contract management.
Strong data analysis and reporting skills for program performance metrics.
Experience developing training programs and leading stakeholder education sessions.
Demonstrated ability to lead cross‑functional teams and drive process improvements.
Additional Information Work From Home / Internet Statement:
Home or hybrid employees must provide a self‑provided internet service that meets a minimum download speed of 25 Mbps and an upload speed of 10 Mbps; wireless, wired, cable or DSL connections are suggested. Satellite, cellular and microwave connections may be used only if approved by leadership. Employees who live and work from home in California, Illinois, Montana or South Dakota will receive a bi‑weekly payment for their internet expense. Humana will provide telephone equipment appropriate for business requirements. Employees must work from a dedicated space that protects member PHI/HIPAA information.
Travel:
Occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours:
40
Pay Range:
$71,100 - $97,800 per year This job is eligible for a bonus incentive plan based upon company and/or individual performance.
Description of Benefits Humana, Inc. and its affiliated subsidiaries offer competitive benefits that support whole‑person well‑being, including medical, dental and vision, 401(k) retirement savings plan, time off, short‑term and long‑term disability, life insurance and many other opportunities.
Application Deadline 01‑09‑2026
About Humana Humana Inc. (NYSE: HUM) is committed to putting health first for teammates, customers and the company. Through our Humana insurance services and CenterWell healthcare services, we enable millions of people to achieve their best health.
Equal Opportunity Employer Humana does not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. Humana also takes affirmative action to employ and advance individuals with disability or protected veteran status.
#J-18808-Ljbffr