Network Optimization Lead
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AI Summary
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Join the Humana team as a Network Optimization Lead. In this role you will drive network optimization and value, manage compliance with network requirements - including network adequacy - for Humana's Illinois Medicaid plan. Reporting to the Network Optimization Principal, you will help analyze provider network performance, support Provider Contracting and project manage terminations. You will work closely with the Provider Relations team to understand and address network operational issues and advise on network composition and value-based payment strategy.Main Responsibilities
- Contribute to strategy for Humana's Illinois Medicaid plan provider network, including contracting approaches, unique partnerships, and deployment of value-based care models to assure long-term, mutually successful provider relationships.
- Analyze internal and external data, and market intelligence information.
- Monitor network adequacy data to inform targeted contracting opportunities and manage resolution process in the event of network terminations.
- Manage provider network strategic plans and their tactical execution, ensuring alignment to financial, operational and clinical goals.
- Lead network governance meetings to identify network issues, ensure compliance with Illinois Department of Healthcare and Family Services (HFS) requirements, and support network operations.
- Monitor performance against measurements and contractual commitments and requirements to ensure compliance. Work with health plan leadership to drive operational efficiencies and improve performance.
- Solve complex network adequacy challenges.
- Work with Network Optimization Principal, Provider Services Director, health plan finance, and clinical and quality teams to achieve strategic goals and priorities.
Use your skills to make an impact
Required Qualifications
Bachelor's degree and a minimum of 5 years of experience in Medicaid managed care operations, network contracting, network operations, and/or network development; or
In lieu of a bachelor's degree, a minimum of 7 years of experience in Medicaid managed care operations, network contracting, network operations, and/or network development.
2 or more years' experience in provider relations
2 or more years of experience with Power BI, Excel- analyzing data and identifying gaps and solutions
Reside in the State of Illinois
Preferred Qualifications
Master's Degree.
Understanding of Illinois Medicaid contractual requirements and provider landscape.
Expertise in value-based payment models.
Knowledge of Humana's internal policies, procedures, and systems.
Additional Information
Workstyle: Remote- Home
Typical Workdays/Hours: Monday - Friday, 8:00am - 5:00pm Central Standard Time (CST)
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
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, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
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