Senior Network Optimization Professional - Ohio Duals - Humana
Boston, MA
About the Job
Become a part of our caring community and help us put health first
The Senior Network Optimization Professional oversees various efforts involving highly complex data analysis and consultation projects/contracts. The Senior Network Optimization Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Senior Network Optimization Professional drives network optimization and value through managing network contracting governance, process development, and data governance for Ohio Duals business, including contracting requirements and data integrity as required by CMS, The Ohio Department of Medicaid, and Humana internal reporting compliance. This role will support network optimization and governance through the development of governance tools, processes, and polices for the OH Medicaid Network Optimization team. This role will work closely with internal partners to facilitate the creation of reporting and tools needed to meet regulatory requirements and to transition from an adequate to a fully optimized network.
Responsibilities
+ Drives network optimization and value through network contracting governance, process development, and data governance Ohio DSNP expansion, including developing contracting requirements, internal reporting compliance processes and supporting data integrity as required by CMS, ODM, and Humana internal policies and procedures.
+ Supports network optimization and governance through the development of governance tools, processes, and polices for the Humana Healthy Horizons Ohio Network Optimization team.
+ Works closely with internal partners to facilitate the creation of reporting and tools needed to meet regulatory requirements and to transition from an adequate to a fully optimized network.
+ This role will report to a Network Optimization Lead
Use your skills to make an impact
Required Qualifications
+ Bachelor's Degree or Equivalent Experience (4 years of relevant experience)
+ 3+ years of provider network contracting or provider data management experience
+ 2+ years of process creation or improvement experience
+ Some knowledge/exposure to Dual Eligible products
+ Strong knowledge of provider network operations tools, processes, and best practices
+ Ability to manage and prioritize multiple projects
+ Proficiency at achieving results within a highly matrixed organization
+ Proficient in MS Office Applications including SharePoint, Teams, MS Word, PowerPoint, Outlook, and Excel
+ Excellent written and verbal communication skills
+ Ability to travel up to 10%
Preferred Qualifications
+ Master's Degree
+ Strong familiarity with DSNP, Medicaid Managed Care, OH Medicaid, and/or OH Medicaid NextGen program to actively advocate for Network Optimization's network priorities with internal stakeholders and shared services
+ Proficiency in Microsoft Access
+ Proficiency in SQL
Additional Information
Work-At-Home Requirements
To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
+ 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
+ Associates 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 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
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, 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 an email correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. (please be sure to check your spam or junk folders often to ensure communication isn't missed) 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 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.$76,800 - $105,800 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 because he or she is a protected veteran. 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=Humana_Website.
The Senior Network Optimization Professional oversees various efforts involving highly complex data analysis and consultation projects/contracts. The Senior Network Optimization Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Senior Network Optimization Professional drives network optimization and value through managing network contracting governance, process development, and data governance for Ohio Duals business, including contracting requirements and data integrity as required by CMS, The Ohio Department of Medicaid, and Humana internal reporting compliance. This role will support network optimization and governance through the development of governance tools, processes, and polices for the OH Medicaid Network Optimization team. This role will work closely with internal partners to facilitate the creation of reporting and tools needed to meet regulatory requirements and to transition from an adequate to a fully optimized network.
Responsibilities
+ Drives network optimization and value through network contracting governance, process development, and data governance Ohio DSNP expansion, including developing contracting requirements, internal reporting compliance processes and supporting data integrity as required by CMS, ODM, and Humana internal policies and procedures.
+ Supports network optimization and governance through the development of governance tools, processes, and polices for the Humana Healthy Horizons Ohio Network Optimization team.
+ Works closely with internal partners to facilitate the creation of reporting and tools needed to meet regulatory requirements and to transition from an adequate to a fully optimized network.
+ This role will report to a Network Optimization Lead
Use your skills to make an impact
Required Qualifications
+ Bachelor's Degree or Equivalent Experience (4 years of relevant experience)
+ 3+ years of provider network contracting or provider data management experience
+ 2+ years of process creation or improvement experience
+ Some knowledge/exposure to Dual Eligible products
+ Strong knowledge of provider network operations tools, processes, and best practices
+ Ability to manage and prioritize multiple projects
+ Proficiency at achieving results within a highly matrixed organization
+ Proficient in MS Office Applications including SharePoint, Teams, MS Word, PowerPoint, Outlook, and Excel
+ Excellent written and verbal communication skills
+ Ability to travel up to 10%
Preferred Qualifications
+ Master's Degree
+ Strong familiarity with DSNP, Medicaid Managed Care, OH Medicaid, and/or OH Medicaid NextGen program to actively advocate for Network Optimization's network priorities with internal stakeholders and shared services
+ Proficiency in Microsoft Access
+ Proficiency in SQL
Additional Information
Work-At-Home Requirements
To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
+ 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
+ Associates 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 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
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, 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 an email correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. (please be sure to check your spam or junk folders often to ensure communication isn't missed) 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 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.$76,800 - $105,800 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 because he or she is a protected veteran. 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=Humana_Website.
Source : Humana