Associate Director, Medicaid Provider Services

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Humana Healthy Horizons is seeking an Associate Director, Medicaid Provider Services to serve in a strategic leadership role within Humanas Corporate Medicaid segment. The Medicaid Provider Services team, led by the Associate Director, is accountable for Humanas Medicaid segment strategy and operationalizing the operational strategy related to provider relations, provider performance improvement, and network management. This leader will work closely with Medicaid markets to stand up their related staffing, processes, and tools to ensure compliance with contractual requirements and foster effective Market operations and positive provider experiences.

The Associate Director partners cross-functionally on matters of significance to enable Medicaid markets to deliver best in class provider experiences that complies with all related contractual requirements. Decisions are typically related to setting clear expectations for associates, developing strategic plans, implementing processes and procedures, and/or resolving complex technical and operational challenges. This leader should have prior experience working in these business areas for a health plan and expertise in setting and executing on strategy, developing and leading teams, and working in matrixed environments.

The Associate Director, Medicaid Provider Services Key Role Objectives:

Lead a dynamic and agile team responsible for developing and enhancing Humana Medicaids standard Provider Support strategy and implementing standard and tailored Provider Support Model solutions in new Medicaid markets.

Oversee the strategic development, delivery, and ongoing refinement of Humana Medicaid Provider Support Model to drive optimal provider experience and performance in alignment with organizational goals.

Oversee the Provider Support Model associated with implementation and operations of Provider Relationship Management model.

Drive development of operational processes, trainings, and KPIs to execute on the Medicaid Provider Relationship Management model, and other strategic initiatives.

Develop and implement various standards, resources, tools, and best practices sharing across the organization.

Accountable for teams effective and timely implementation of provider services business functions in new Medicaid markets in alignment with Humana Medicaid standards and tailored to local market nuances and contractual requirements ( Provider services functions include but not limited to local market provider relations, provider performance, and claims education staffing, standard operating procedure development, tailored provider education materials development, and provider onboarding plan development and execution).

Assist with hiring of new market Provider Services department leadership and serve as a mentor through post-go-live transition.

Serve as segments subject matter expert on provider relations and provider engagement/performance improvement.

Provide oversight of development of solutions to relevant non-standard contractual requirements and/or local needs of each Medicaid market.

Assist with strategy development and staffing plans for new market requests for proposal (RFP).

Define and maintain team strategic priorities, scope of work, roles and responsibilities, and policies and standard operating procedures for associates.

Set clear goals, expectations, and roles and responsibilities for team members. Support Director with resource planning and market assignments to team members.

Improve standard operating procedures over time to drive efficiencies and repeatable processes.

Cultivate strong working relationships with matrixed organization partners, including operational/shared services areas, needed to support provider services implementations and operations.

Support team members to be successful in their roles, including regular 1:1s, semi-annual performance reviews, and performance coaching, as needed, to ensure positive work environment that promotes associate retention and high-quality work products.

Use your skills to make an impact

Required Qualifications

Must work hours within the Eastern Standard Time Zone.

Bachelors Degree.

6 years of progressive leadership experience with the ability to stand up and lead a new team, including setting expectations and developing new processes.

9 years of experience in provider relations and network development at a health plan.

Experience and understanding of Medicaid.

Experience with defining strategic priorities and plans to execute on those priorities.

Proven expertise in driving operational efficiencies and management of timelines and processes.

Highly adept at managing processes from concept to completion ensuring on-time, on-budget, and on-target results.

Exceptional time management and ability to manage multiple priorities in a fast-paced environment.

Work at Home Requirements

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

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

Humana will provide Home or Hybrid Home/Office associates 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.

Preferred Qualifications

Masters Degree.

Experience standing up new health plan operations and/or implementations.

Experience with claims processing, root cause analysis, and resolution.

Experience with provider performance improvement.

Additional Information

Direct Reports: 4 current direct reports.

Travel : None, except for possible annual meeting at a Humana office location.

Workstyle: Remote, must work hours within the eastern time zone.

Core Workdays & Hours: Typically, 8-5 pm Monday – Friday; Eastern Standard Time (EST)

Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more…..

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

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.$112,400 – $154,900 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, Humana) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=HumanaWebsite.