Network Optimization Professional

Humana • Work at Home - Illinois, IL

2d • $59,300 - $80,900 • Remote

About The Position

Join our Illinois Market team in this exciting role as a Network Optimization Professional! Reporting to the Network Optimization Principal, you will play an important role on the Network Optimization team with assisting to ensure compliance with network requirements, including network adequacy, for Humana's Illinois Medicaid plan.

Requirements

• Bachelor's degree with 2+ years of experience in Medicaid managed care operations, provider network contracting, network operations, or network development.
• Candidates without a bachelor's degree may qualify with 3+ years of experience in Medicaid managed care operations, network contracting, network operations, or network development.
• 1 year of experience auditing Provider Contract audits and Quality Assurance of Provider Network loading.
• 2 years of Microsoft Office applications experience- Word, Excel, PowerPoint
• Reside within the State of Illinois

Nice To Haves

• Familiarity with identifying network issues, ensure compliance with Illinois Department of Healthcare and Family Services (HFS) requirements, and support network operations.
• Ability to run large-scale, visible programs with responsibility for multiple project teams.
• Knowledge of Humana's internal policies and procedures.

Responsibilities

• Analyze provider network performance by auditing Provider contracts and ensuring Quality Assurance on Provider loading.
• Triage the Provider Escalation tracker and collaborate with departments to manage tasks.
• Analyze internal and external data, and market intelligence information.
• Monitor network adequacy data to inform targeted contracting opportunities and assist the Network Optimization Lead with provider terminations.
• Support the Network Optimization Lead on other responsibilities assigned.

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: Mid Level