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Provider Network Optimization Lead

Humana

Humana

Remote
Posted on Wednesday, October 18, 2023

Description

Humana Healthy Horizons in Oklahoma is seeking a Network Optimization Lead who is responsible for driving network optimization and value, while also managing compliance with network requirements, including network adequacy, in the Oklahoma Department of Medicaid Managed Care Contract. The Lead will support the analysis of provider network performance to inform contracting and terminations, work closely with the Provider Relations team to understand and address network operational issues, and advise on network composition and value-based payment strategy. This position works on problems of diverse scope and complexity ranging from moderate to substantial. This is a collaborative role requiring critical thinking and problem-solving skills, independence, tactical execution on strategy, and attention to detail. This position reports to the Director, Network Optimization.

You will be part of a caring community at Humana. When you meet us, you can tell we started as a hometown company. We’re proud of our Louisville roots and, as we’ve grown, that community feeling has spread across all 50 states and Puerto Rico. No matter where you are—whether you’re working from home, from the field, from our offices, or from somewhere in between—you’ll feel welcome here. We’re a caring community made of close-knit teams, cross-country friendships, and inclusive resource groups, all gathered around one big table where everyone’s voice is heard and respected. Community is a verb here. It’s up to each of us to care for it and maintain it. Because the relationships we form will help us deliver better health outcomes for the people we so proudly serve.

Are you Caring, Curious and Committed? If so, apply today!

Responsibilities

The Network Optimization Lead

  • Contribute to strategy for Oklahoma Medicaid 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, as well as 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 initiatives and their tactical execution, ensuring alignment to financial, operational and clinical goals
  • Lead network governance meetings to proactively identify network issues, ensure compliance with Oklahoma Department of Medicaid requirements, and support network operations
  • Monitor performance against key performance indicators and contractual commitments and requirements to ensure compliance. Work with health plan leadership to drive operational efficiencies and improve performance
  • Solve complex business challenges
  • Work collaboratively with Chief Operating Officer, Provider Services Director, health plan finance, and clinical and quality teams to achieve strategic goals and priorities
  • Uses independent judgment requiring analysis of variable factors and determining the best course of action

Required Qualifications

  • Must reside in Oklahoma
  • Bachelor's Degree
  • 8 or more years of experience in Contracts, Business Development, Program Management, Operations, Finance or other relevant/related experience within the healthcare industry
  • Previous experience working with provider contracting or provider operations
  • Advanced experience leading special projects and producing metrics, measurements and trend reports
  • Strategic thinking and planning capabilities; organized and detail-oriented
  • Demonstrated ability to run large scale, highly visible programs with responsibility for multiple project teams
  • Proficiency in Microsoft Office applications including Microsoft Project
  • Willingness to manage and prioritize diverse projects
  • Excellent written and verbal communication skills
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

  • Master's Degree
  • Knowledge of Humana's internal policies, procedures and systems
  • Six Sigma and/or PMP certification

Additional Information

About Humana

Your growth is what drives Humana forward.

  • When you get here, the journey is just beginning. Our leaders are committed to understanding what you need to grow. Because we don’t grow without you
  • This is a place where our nurses influence the C-suite
  • Where software engineers change lives
  • Where every associate can build a professional path where they learn and thrive
  • Through our commitments to wellbeing and work-life balance, we support each associate’s personal health, purpose, work style, sense of belonging, and security
  • Because finding new ways to put health first—for our members and patients and our associates alike—is what we do

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

  • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
  • Satellite, cellular and microwave connection can be used only if approved by leadership
  • Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
  • Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
  • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40