Manager Provider Relations

Humana • Work at Home - Illinois, IL

1d • $86,300 - $118,700 • Remote

About The Position

Reporting to the Director, Provider Engagement, you will lead a team of provider relations associates. You will be responsible for growing positive, long-term relationships with network of LTSS providers in Humana's Dual Fully Integrated and Humana Healthy Horizons plans of Illinois through day-to-day, front-line relationship management.

Requirements

• Must reside in Illinois
• A Bachelor's Degree is required, accompanied by 4 or more years of progressive experience in managed care operations. This experience should include network management and provider relations.
• Alternatively, a High School Diploma is acceptable, as long as it is paired with 7 or more years of progressive experience in managed care operations, including network management and provider relations.
• 3+ years of experience in Medicaid
• 2+ years of management and team building experience including supervising a staff of at least 5-10 employees
• Experience working for or with key provider types (such as primary care, FQHCs, hospitals, nursing facilities, and/or HCBS and LTSS providers)
• 25% Travel required throughout Illinois
• Valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits.
• Minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required for internet service.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Nice To Haves

• Master's Degree
• 1 or more years of contract negotiation and implementation experience
• Experience in and/or understanding of Illinois Medicaid, provider landscape and networks

Responsibilities

• Explain and administer company policies/information required for team members to successfully perform their duties
• Train and Educate team on platforms and systems used in everyday work
• Manage teamwork assignments to ensure adequate coverage to meet quality and service levels
• Conduct regular performance evaluation of employees and provide ongoing feedback and coaching as necessary to achieve service, quality, and production goals
• Monitor state standards and guidelines and coordinate interdepartmentally and externally to confirm alignment
• Ensure a solid understanding of Evidenced based Practices programs (ACT, MST, FFT, Homebuilders)
• Ensure prompt responsiveness and appropriate triage of provider inquiries, concerns, or problems, including those associated with claims payment, prior authorizations, and referrals, as well as appropriate education about participation in Humana’s Virginia Medicaid plan
• Work with internal corporate partners to ensure cross-department communication and resolution of provider’s issues
• Work with internal resources and systems (e.g., claims, reimbursement, provider enrollment) to provide the Perfect Experience in all provider interactions with Humana’s Dual Fully Integrated plan of Illinois. Ensure compliance with Illinois’s managed care contractual requirements for provider relations, such as claims dispute resolution within specified timeframes

Benefits

• medical
• dental
• 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

What This Job Offers

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