Health Plan Liaison

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The Provider Engagement, Clinical Executive develops and grows positive, long‑term relationships with physicians, providers, and healthcare systems to support financial and quality performance within contracted relationships with the health plan. The role involves working on problems of diverse scope and complexity ranging from moderate to substantial.

As the focal point for the health plan/provider relationship, the Executive addresses financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, operational improvements, and other related areas. The work directly impacts provider performance, member experience, market growth, provider experience, and operational excellence. The position reports to the Director, Quality Improvement and involves complex issue analysis and course‑of‑action determination.

Responsibilities

Support and execute the market’s provider engagement strategy, including VBP, high‑volume FFS, and dual‑eligible memberships.

Determine meeting type (JOC, Clinical/Quality, Operation) and frequency.

Develop or standardize provider meeting presentations and reporting packages.

Create provider scorecards.

Profile market provider performance and develop strategies to target low‑performing providers.

Relate performance data and details to physicians, providers, and health systems.

Develop adoption strategies for market and corporate tools and methodologies.

Oversee plans and implement provider‑facing QI programs, including scorecard monitoring, gaps in care reports, CAHPS survey results, and behavioral health measures.

Contribute to development and oversight of care coordination and outcome reporting.

Help develop the quality strategy for all provider‑facing activities, including participation in integrated care internal workgroups.

Collaborate on development of market value‑based provider incentive programs for PCPs, specialists, hospitals, and clinics.

Required Qualifications

Registered Nurse OR a Bachelor’s degree in Social Work, Public Health, or Health Administration.

Must reside in the state of Wisconsin.

Ability to travel up to 10% within the Milwaukee area and to provider offices throughout the state.

Minimum 3 years developing or implementing clinical strategies focused on provider outcomes.

Experience in provider clinical programs, payer clinical programs, or value‑based care organizations.

Direct experience working with leaders of provider organizations.

Basic knowledge of an integrated care delivery system, Federally Qualified Health Center (FQHC), HEDIS, and STARS.

Preferred Qualifications

Experience in clinical practice working with or within a provider organization.

Implement quality improvement programs and strategies.

Use healthcare data and analytics to inform program development.

Hybrid / Travel Requirements

This is a hybrid role with up to 10% travel in and around the Milwaukee area and to provider offices throughout Wisconsin.

Driving Requirements

Individuals must hold a valid state driver’s license and maintain personal vehicle liability insurance in accordance with state minimum required limits or $25,000 bodily injury per person/$25,000 bodily injury per event/$10,000 property damage, whichever is higher.

Benefits

Health benefits effective day 1.

Paid time off, holidays, volunteer time, and jury duty pay.

Recognition pay.

401(k) retirement savings plan with employer match.

Tuition assistance and scholarships for eligible dependents.

Parental and caregiver leave.

Employee charity matching program.

Network Resource Groups (NRGs) and career development opportunities.

Work Hours and Compensation

Scheduled weekly hours: 40.

Pay range: $86,300 - $118,700 per year.

Equal Opportunity Employer

It is the policy of Humana not to 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. It is also the policy of Humana to take affirmative action to employ and advance individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy applies to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other compensation, and selection for training, including apprenticeship, at all levels of employment.

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