Provider Engagement​/Relations Manager

Become a part of our caring community and help us put health first

The Manager, Provider Engagement/Relations will lead and support a team of Provider Relationship Managers dedicated to ensuring an exceptional provider experience for Humana Healthy Horizons’ Oklahoma Medicaid plan. This leader will oversee relationship management, provider engagement, training, onboarding, issue resolution, and operational compliance, with the goal of driving provider satisfaction, network retention, and adherence to regulatory requirements.

• Lead, coach, and develop a team responsible for serving as the primary point of contact for physical and behavioral health providers in the Oklahoma Medicaid network.
• Oversee the planning and execution of regular in-person and virtual meetings with providers to deliver training, education, and orientation regarding Humana policies, procedures, and systems.
• Ensure new providers receive effective onboarding support, including orientation sessions and timely access to necessary resources.
• Supervise the team's response to provider questions and inquiries, ensuring prompt and accurate resolution in collaboration with internal enterprise business teams (e.g., claims, prior authorization, referrals, provider education).
• Guide the coordination and facilitation of Service Operating Committee meetings with providers, ensuring effective agendas, materials, and cross-functional participation (clinical, provider engagement, etc.).
• Ensure timely and clear communication of updates regarding Humana’s policies, procedures, and Oklahoma’s Sooner Select program to network providers.
• Direct the planning and execution of regional provider townhalls and trainings to promote engagement and satisfaction.
• Collaborate with internal operational teams (e.g., claims, reimbursement, provider enrollment) to support high‑quality provider interactions.
• Monitor and enforce compliance with Oklahoma managed care contractual requirements, including provider relations processes such as claims dispute resolution within required time frames.
• Use data, feedback, and performance metrics to identify trends and implement continuous improvement strategies for provider engagement and retention.
• Represent the Provider Relations function in cross‑departmental meetings and initiatives as needed.

• Must reside in Oklahoma
• 4+ years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience
• 2+ years of demonstrated management experience and partnering with senior leadership on strategic initiatives
• Proven planning, preparation and presentation skills, with established knowledge of reimbursement and bonus methodologies
• Demonstrated ability to manage multiple projects and meet deadlines
• Comprehensive knowledge of all Microsoft Office applications
• Ability to travel, as needed

• Bachelor’s Degree
• Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance
• Comprehensive knowledge of Medicare policies, processes and procedures

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

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.

Satellite, cellular and microwave connection can be used only if approved by leadership.

Employees 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 employees 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.

Travel:
While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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