Provider Network Optimization Lead

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

Humana Healthy Horizons in Oklahoma is seeking a Provider Network Optimization Lead who is responsible for driving network optimization and value, while also managing compliance with network requirements, including network adequacy, in the Oklahoma Department of Medicaid Managed Care Contract. The Lead will support the analysis of provider network performance to inform contracting and terminations, work closely with the Provider Relations team to understand and address network operational issues, and advise on network composition and value-based payment strategy. This position works on problems of diverse scope and complexity ranging from moderate to substantial. This is a collaborative role requiring critical thinking and problem-solving skills, independence, tactical execution on strategy, and attention to detail. This position reports to the Director, Network Optimization.

You will be part of a caring community at Humana. When you meet us, you can tell we started as a hometown company. We're proud of our Louisville roots and, as we've grown, that community feeling has spread across all 50 states and Puerto Rico. No matter where you are-whether you're working from home, from the field, from our offices, or from somewhere in between-you'll feel welcome here. We're a caring community made of close-knit teams, cross-country friendships, and inclusive resource groups, all gathered around one big table where everyone's voice is heard and respected. Community is a verb here. It's up to each of us to care for it and maintain it. Because the relationships we form will help us deliver better health outcomes for the people we so proudly serve.

Are you Caring, Curious and Committed? If so, apply today!

Responsibilities

1. Contribute to strategy for Oklahoma Medicaid provider network, including contracting approaches, unique partnerships, and deployment of value-based care models to assure long term mutually successful provider relationships
2. Design and analyze internal and external data, as well as market intelligence information
3. Monitor network adequacy data to inform targeted contracting opportunities and manage resolution process in the event of network terminations.
4. Manage provider network strategic initiatives and their tactical execution, ensuring alignment to financial, operational and clinical goals
5. Lead network governance meetings to proactively identify network issues, ensure compliance with Oklahoma Healthcare Authority (OHCA) requirements, and support network operations
6. Monitor performance against key performance indicators and contractual commitments and requirements to ensure compliance. Work with health plan leadership to drive operational efficiencies and improve performance
7. Solve complex business challenges
8. Work collaboratively with Chief Operating Officer, Provider Services Director, health plan finance, and clinical and quality teams to achieve strategic goals and priorities
9. Use independent judgment requiring analysis of variable factors and determining the best course of action

Required Qualifications

1. Prefer residence in OK, but not required
2. Bachelor's Degree in Healthcare, Analytics and/or Finance
3. 8 or more years of experience in Healthcare Analytics, Contracts, Business Development, Program Management, Operations, Finance, Value Based Care or other relevant/related experience within the healthcare industry
4. Advanced experience leading special projects and producing metrics, measurements and trend reports
5. Strategic thinking and planning capabilities; organized and detail-oriented
6. Demonstrated ability to run large scale, highly visible programs with responsibility for multiple project teams
7. Proficiency in Microsoft Office applications including Microsoft Project
8. Willingness to manage and prioritize diverse projects
9. Excellent written and verbal communication skills

Preferred Qualifications

1. Master's Degree
2. Knowledge of Humana's internal policies, procedures and systems
3. Six Sigma and/or PMP certification

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 year. This 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.