Network Optimization Lead

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.

• 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.

• 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

• 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.

Workstyle:
Remote
- Home

Typical Workdays/

Hours:

Monday - Friday, 8:00am - 5:00pm Central Standard Time (CST)

Work at Home Requirements:
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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. 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.

Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $115,200 - $158,400 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support…