Network Optimization Lead

Humana • Work at Home - Illinois, IL

2d • $115,200 - $158,400 • Remote

About The Position

Become a part of our caring community. 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.

Requirements

• 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

Nice To Haves

• 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.

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.

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: Senior