Provider Engagement Consultant Resume Samples
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Provider Engagement Consultant Resume Samples
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IH
I Hoeger
Ivy
Hoeger
954 Green Brook
Philadelphia
PA
+1 (555) 385 6947
954 Green Brook
Philadelphia
PA
Phone
p
+1 (555) 385 6947
Experience
Experience
New York, NY
Provider Engagement Consultant
New York, NY
Leffler-Schmeler
New York, NY
Provider Engagement Consultant
- Advocate the use of Provider Tools, Online technology and health plan resources, (e.g. LINK, UHC Online, Provider Manuals)
- Work with provider consultants, contracting, finance, etc
- Manage provider groups to achieve quality and P&L goals
- Identify and work with providers with focus on growth and retention of UnitedHealthcare Community Plan members
- Manage provider groups to achieve quality and P & L goals
- Working knowledge of HEDIS and Stars Measures as well as Care Management
- Coordinate activities/events with providers to promote the health plan and educate members on value added services offered by the health plan
Chicago, IL
Provider Engagement Consultant
Chicago, IL
Reinger-Jacobs
Chicago, IL
Provider Engagement Consultant
- Develop strong relationships with providers and their office management teams
- Solicit provider informal and formal feedback via surveys, complaints and conversations in order to develop action plans (e.g., corrective actions; suggestions to leadership; complaint resolution processes)
- Maintain strong business relationships to ensure retention of existing contracted providers, therefore decreasing loss in membership due to provider terminations
- Help identify and pursue potential providers who could become an asset to promote the health plan’s overall health care initiatives and quality of service
- Manage provider continuum, prospecting other providers for value based opportunities
- Develop and/or implement processes and data sharing structure for assigned providers
- The person in this role will collaborate with passive, risk, or value providers and all departments in Network Operations
present
Houston, TX
Senior Products Provider Engagement Consultant
Houston, TX
Miller-Brakus
present
Houston, TX
Senior Products Provider Engagement Consultant
present
- Facilitate relationship engagement and collaboration with key Medicare Advantage provider healthcare systems, driving performance management of revenue and cost through achievement of quality initiatives and implementation of growth strategies
- Conduct regular key provider committee sessions with agendas and supporting data addressing performance opportunities
- Develop and promote strategies utilizing internal Contracting, Sales, Clinical, Quality, MRA and Finance teams to foster provider system partnership growth and performance success
- Analyze, provide and present financial and operational data, and ensure action plans are implemented to achieve performance goals
- Deliver world-class, perfect service to engaged groups to optimize communication, coordination and collaboration resulting in successful engagement relationships and business results
- Builds Trust:Consistently models and inspires high levels of integrity, lives up to commitments, and takes responsibility for the impact of one's actions
- Collaborates: Engages others by gathering multiple views and being open to diverse perspectives, focusing on a shared purpose that puts Humana's overall success first
Education
Education
Bachelor’s Degree
Bachelor’s Degree
Indiana University
Bachelor’s Degree
Read our complete resume writing guides
1
Provider Engagement Consultant Resume Examples & Samples
- Healthcare experience with an understanding of Medicare
- Comprehensive knowledge of Microsoft Word & Excel
- Provider/Physician Office experience
2
Senior Products Provider Engagement Consultant Resume Examples & Samples
- Facilitate relationship engagement and collaboration with key Medicare Advantage provider healthcare systems, driving performance management of revenue and cost through achievement of quality initiatives and implementation of growth strategies
- Conduct regular key provider committee sessions with agendas and supporting data addressing performance opportunities
- Develop and promote strategies utilizing internal Contracting, Sales, Clinical, Quality, MRA and Finance teams to foster provider system partnership growth and performance success
- Provide education, reports, resources and tools to engaged providers to improve appropriate utilization of health services, quality outcomes, HEDIS measures, and best practices
- Work collaboratively with providers to optimize accurate documentation and appropriate coding for MRA, and to assure timely delivery and reporting of HEDIS services in conjunction with MRA and Quality Improvement teams
- Analyze, provide and present financial and operational data, and ensure action plans are implemented to achieve performance goals
- Deliver world-class, perfect service to engaged groups to optimize communication, coordination and collaboration resulting in successful engagement relationships and business results
- Prior experience in a fast paced insurance, health care or related setting
- Proven planning and preparation skills, with established knowledge of various reimbursement and bonus methodologies
- Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses, and quality/bonus performance
- Proficiency in integrating business functions and efficiencies
- Computer literate (MS Word, Power Point, Excel, MS access)
- Excellent communication skills, both oral & written, experience in group presentation
- Knowledge of Humana's internal policies, procedures and systems
3
Provider Engagement Consultant Resume Examples & Samples
- Strong relationship building skills, preferably in a provider relations/network environment
- Prior experience in health care, health plan or provider facility
- Must be flexible with travel
- Must reside in Tyler and/or Longview
- Associates and/or Bachelor’s Degree
4
Provider Engagement Consultant Resume Examples & Samples
- Experience communicating complex content
- Relationship building skills and Strong communicator; capable of effectively presenting ideas and selling concepts
- Experience with Microsoft Office (Word, Power Point, Excel, Access)
- Valid driver’s license and proof of personal vehicle liability insurance with at least 100/300/100 limits
- Graduate Degree
- Medicare knowledge
- Project Management and Six Sigma and/or Lean certification
5
Provider Engagement Consultant Resume Examples & Samples
- Design and execute profitable growth strategies to align with the Provider Engagement Director’s market strategy and the provider’s needs
- Develop and/or implement processes and data sharing structure for assigned unengaged providers
- Strong facilitation skills with an ability to run provider meetings with prioritized specific topic agenda reflecting entire provider support organization
- Develop and review Dashboard Metrics (quality, financial, triple AIM) and translate into actionable items based on group specifics
- Work with providers on entry level platform with intent to educate on path to risk, assist with gap closure, educate around Humana Pharmacy and risk adjustment as well as Care Management programs
- Ability to train others to use the tools that will enable the PCP to be successful
- Partner with all internal stakeholders and leverage the experience from all departments
- Be the defined point of contact for your assigned providers
- Escalate claims issues to the SAM on provider behalf to improve the provider experience
- Manage provider continuum, prospecting the provider’s readiness for enhanced value based opportunities
- Bachelor’s Degree (strongly preferred)
- Experience thriving in a matrix environment
- Excellent PC skills (including MS Word, Power Point, Excel) and proven analytical skills
- Prior experience with Medicare Advantage lines of business
- Working knowledge of value based collaborations (e.g. Accountable Care Organizations)
- Working knowledge of HEDIS and Stars Measures as well as Care Management
6
Provider Engagement Consultant Resume Examples & Samples
- Work with providers on entry level platform with intent to educate on path to risk, assist with gap closure, educate around Humana Pharmacy and Medicare Risk Adjustment as well as Care Management programs
- Prior experience in healthcare setting
- Excellent PC skills and proven analytical skills
- Ability to handle multiple tasks and deadlines with attention to detailThis 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
- Bachelor's degree preferred
- Prior experience with Medicare Advantage
7
Provider Engagement Consultant Resume Examples & Samples
- Design and execute profitable growth strategies
- Develop and/or implement processes and data sharing structure for assigned providers
- Strong facilitation skills with an ability to run provider meetings (JOC or PCP meeting) with prioritized specific topic agenda reflecting entire provider support organization
- Create spreadsheet forecasting models and develop database tools to assist senior management in provider/customer negotiations, to measure growth and monitor profitability
- Ability to train others to use the tools that will make the PCP successful
- Facilitate clinical education, leveraging clinical experience from your internal partners
- Ability to provide actionable financial and operational data, and ensure action plans are implemented to achieve performance goals
- Be the defined point of contact for the provider and communication according to group agreements
- Manage provider continuum, prospecting other providers for value based opportunities
- Influence provider culture and strategy to elevate capability of the provider community to support the ever changing healthcare environment
- Work to improve EMR capability
- Partner with the provider and the company to develop capability for sustained, integrated consumer interaction programs building consumer and customer advocacy and loyalty
- Possess a deep understanding of segmentation and/or market segment opportunity, product development and product positioning; able to direct the implementation activities for a team of stakeholders
- Work in a consultative role with various departments locally and at corporate headquarters in creating effective information and analyses in order to optimize the market’s strategic objectives
8
Provider Engagement Consultant Resume Examples & Samples
- Be a strong partner and build relationships with internal stakeholders to create a seamless experience for the provider
- Be the defined point of contact for your assigned providers Manage provider continuum, prospecting other providers for value based opportunities
- Ability to build strong relationships, identify risk, remove barriers and improve clinical outcomes and the member experience
- Proficient in Word, Excel & PowerPoint
- Excellent relationship building skills with both internal and external partners
- Business and financial acumen in the health care field
- Experience working with prominent provider groups
- Experience working with Medicare Advantage Plan
9
Provider Engagement Consultant Resume Examples & Samples
- Manage provider groups to achieve quality and P & L goals
- Create provider partnerships to improve health efficiencies and foster provider experience while ensuring cohesion across product lines
- The person in this role will collaborate with passive, risk, or value providers and all departments in Network Operations
- Strong facilitation skills with an ability to run provider meetings (JOC or PCP meeting) with prioritized specific topic agenda reflecting entire provider support organizations
- Healthcare and/or managed care experience
- Develop strategies and actions based upon data analysis/reports
- Experience with Medicare Advantage
10
Provider Engagement Consultant Resume Examples & Samples
- Prior experience in healthcare or managed care
- Ability to handle multiple tasks and deadlines with attention to detail. 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
- Working knowledge of value based collaborations, HEDIS & Stars Measures
11
Provider Engagement Consultant Resume Examples & Samples
- Identify and work with providers with focus on growth and retention of UnitedHealthcare Community Plan members
- Help identify and pursue potential providers who could become an asset to promote the health plan’s overall health care initiatives and quality of service
- Execute plan marketing strategies to increase market share in Service Delivery Area
- Demonstrate understanding of all Texas Medicaid lines of business as they apply to managed care and the needs of the members enrolled in them in order to facilitate their care and resolution of their issues
- Develop strong relationships with providers and their office management teams
- Maintain strong business relationships to ensure retention of existing contracted providers, therefore decreasing loss in membership due to provider terminations
- Educate providers on general policies and procedures applicable to delivery of care (e.g., regulatory; benefit; quality of care)
- Introduce and educate providers on health lifestyle initiatives offered by the health plan for their patients
- Conduct regular visits to providers to introduce new initiatives and monitor success of those in place
- Conduct regular visits to providers to identify issues and ensure effective problem resolution to maintain strong relationships
- Demonstrate understanding of providers' business goals and strategies in order to align them with those of the health plan
- Coordinate activities/events with providers to promote the health plan and educate members on value added services offered by the health plan
- Advocate the use of Provider Tools, Online technology and health plan resources, (e.g. LINK, UHC Online, Provider Manuals)
- Communicate members’ and providers' needs to internal stakeholders in order to drive creation of solutions that meet our mutual business goals
- Work with internal business partners to identify, understand, and/or improve tools, resources, systems, and capabilities that can maximize provider/member experience, or health plan performance
- Collaborate and/or participate in discussions with colleagues and business partners to identify potential root cause of issues
- Analyze data to determine root cause of issue (e.g., identify trends and patterns; identify outliers and anomalies) and/or escalate problem to appropriate business partner for further analysis as necessary
- Involve leadership and/or escalate issues as necessary to implement provider /member solutions
- Respond to providers’ requests by directing them to appropriate internal or external resources
- Solicit provider informal and formal feedback via surveys, complaints and conversations in order to develop action plans (e.g., corrective actions; suggestions to leadership; complaint resolution processes)
- Support member retention events/activities and health plan communal initiatives (e.g. Alzheimer’s Walks, Special Olympics, Ride 2 Recovery, etc.)
- *Position can be located in: Harris County TX (Houston) ***
- 3+ years of years of Marketing experience in a Healthcare environment
- Experience in Provider Relations and Network communications and interactions
- Experience with SharePoint, Windows PC applications and Microsoft Office (Word, Excel, Outlook, and PowerPoint)
- Texas Telecommuter Position
- 70% travel within assigned territory and to other markets as needed (Markets include: Houston, TX
12
Provider Engagement Consultant Resume Examples & Samples
- 3+ years of experience with Marketing in a Healthcare environment or in a Clinical setting
- Experience with Microsoft Office (Word, Excel, Outlook, and PowerPoint)
- Experience with SharePoint
13
Provider Engagement Consultant Resume Examples & Samples
- Computer literate (MS Word, Power Point, Excel). Basic working knowledge of Excel
- Ability to travel 50-75% around the state of Alabama
- Understanding of healthcare metrics to include STARS/HEDIS
- RN or clinical background is desired
14
Provider Engagement Consultant Resume Examples & Samples
- Address provider claims issues and bring to resolution
- Strong facilitation skills with an ability to run provider meetings with prioritized specific topic agenda reflecting entire provider support organizations
- Develop and review Dashboard Metrics and translate into actionable items based on group specifics
15
Provider Engagement Consultant Resume Examples & Samples
- Manage provider groups to achieve quality and P&L goals
- Create strategic provider partnerships with path to value providers to improve their experience with Humana
- Ability to build strong relationships, identifies risk, remove barriers and improve clinical outcomes and the member experience
- Pharmaceutical sales or Physician liaison experience
16
Provider Engagement Consultant Resume Examples & Samples
- Improve coding, and discuss patients that are high utilizers and help members to stop readmissions
- Work with provider consultants, contracting, finance, etc
- Have full responsibility for PL for this region and manage to the budget for medical expenses
- They will reach out to providers via phone with reports to close gaps, etc
- Utilize knowledge of HEDIS and will be trained to enter Stars data
- Provider outreach as needed
- Knowledge of HEDIS
- Comfortable with computer and using excel spreadsheets
- Provider engagement experience
- Strong business and clinical background
- Comfortable with presentations to providers and executive team members
- Strong knowledge of Stars/CMS/Quality
- Previous experience in utilization management
17
Provider Engagement Consultant Resume Examples & Samples
- Manage provider engagement email
- Minimum of an Associate’s degree with a minimum of 3 years of provider relations experience
- Intermediate in MS Word, Power Point, Excel
18
Provider Engagement Consultant Resume Examples & Samples
- Previous experience with direct provider interaction
- 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
- Understanding of HEDIS and Gap closures
19
Provider Engagement Consultant Resume Examples & Samples
- Proven analytical skills, and database manipulation
- Ability to travel 2-3 days per week with occasional overnight travel
- Understanding of Medicare HEDIS measures
20
Provider Engagement Consultant Resume Examples & Samples
- Strong facilitation skills with an ability to run provider meetings (JOC and PCP meetings) with prioritized specific topic agenda reflecting entire provider support organization
- Ability to travel by personal vehicle 2-3 days/week with occasional overnight travel
- Understanding of HEDIS measures
- Spreadsheet modeling experience
21
Provider Engagement Consultant Resume Examples & Samples
- *Position can be located in: Travis Burnet- Williamson- Caldwell- Bastrop- Lee- Fayette Counties TX (Austin) ***
- 70% travel within assigned territory and to other markets as needed ( Areas of coverage- Burnet- Williamson- Caldwell- Bastrop- Lee- Fayette Counties)
- Bachelor’s Degree (or higher)
22
Provider Engagement Consultant Resume Examples & Samples
- Minimum of an Associate's Degree
- Prior experience in a fast paced insurance or health care setting with previous experience interacting with providers
- Bachelor's/RN
