Director, Network Optimization

Humana • Work at Home - Ohio, OH

1d • $138,900 - $191,000 • Remote

About The Position

The Director, Network Development oversees the strategic development and maintenance of Ohio Medicaid plan's provider network. This senior-level strategist is responsible for driving network optimization and value, while also ensuring compliance with network requirements in the Ohio Department of Medicaid Managed Care Contract. The Director will assess provider network performance to inform contracting and terminations, work closely with the Provider Relations team to understand and address network operational issues, and set value-based payment strategy. This is a collaborative role requiring critical thinking and problem solving skills, independence, leadership, a strategic mindset, and attention to detail. This position reports to the plan's Chief Operating Officer.

Requirements

• Bachelor's Degree
• 6+ years of experience working with a managed care organization or as a consultant in a network/contract management role, such as contracting, provider services, etc.
• 2+ years of experience in provider network development, including contracting, network operations, and/or network maintenance
• 4+ years of experience in value-based contracting models
• 2+ years of experience in data analysis
• Proficiency with a wide range of physician/facility/ancillary contract reimbursement methodologies
• Prior leadership and management experience
• Ability to manage multiple priorities in a fast-paced environment
• Experience working in a matrixed organization and influencing change and direction
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Nice To Haves

• Master's Degree
• Experience with the Ohio Medicaid MCO contract, including network adequacy requirements and standards for provider relations compliance
• Experience with Ohio Medicaid value-based programs, including Pediatric ACO Arrangements, Comprehensive Primary Care, and Comprehensive Maternal Care

Responsibilities

• Creates strategy for Ohio Medicaid provider network, including contracting approaches, unique partnerships, and deployment of value-based care models to assure long term mutually successful provider relationships
• Manages provider network strategic initiatives and tactical execution, ensuring alignment to financial, operational and clinical goals
• Leads approach and analytics necessary to drive decisions on provider contract renegotiations and terminations
• Provides market oversight and governance of the management of provider data for the health plan including but not limited to demographics, rates, and contract intent
• Sets value-based payment strategy, in partnership with key leaders, to ensure compliance with contract requirements.
• Provides market oversight and governance of the management of ODM-required value-based payment models, including but not limited to Comprehensive Primary Care
• Monitor performance against key performance indicators and contractual commitments and requirements to ensure compliance.
• Work with health plan leadership to improve performance
• Participates in operating meetings for key provider relationships to facilitate strategic initiatives and improved performance
• Works collaboratively with Chief Operating Officer, Provider Services Director, Market Chief Financial Officer, and clinical and quality teams to achieve strategic goals and priorities

Benefits

• medical, dental and vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Director