Advisor, Medicaid Provider & Network Strategy

at Humana in Springfield, Illinois, United States

Job Description

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

The Advisor, Medicaid Provider & Network Strategy will be accountable for leading the development of Humana Healthy Horizon’s (Medicaid) provider & network market entry strategy for its Medicaid growth markets. This strategist will lead data-driven research oriented strategic advisement in the development of strategies that produce robust, adequate, and accessible networks. The Advisor will also drive the development of competitive & innovative provider & network strategies to support request for proposals (RFPs) and market entry. Such strategies include, but are not limited to access to care, practice transformation, provider relations, alternative sites of care, and value-based purchasing. The position requires an in-depth understanding of how organizational capabilities interrelate within the enterprise to develop and execute on network strategy. This position exercises strong project management skills, analysis of variable source information, independent judgment, and decision making on complex issues related to the job duties and related tasks. Up to 10% travel is expected for this role.

We are seeking an experienced strategist with a track record of synthesizing and evaluating multiple sources of qualitative and quantitative data to define network priorities and build solutions. Excellent interpersonal, organizational, written, and oral communication and presentation skills with proven experience writing and delivering presentations to members of the management team and internal business partners will be critical in this role.

Key responsibilities for this role include:

+ Oversees the creation of a playbook that drives Humana’s provider & network market entry strategy decisions.

+ Works cross functionally to seek consult and provide advisement on a proposed network build approach and timeline based on analysis of internal and external source data and managed care program requirements.

+ Drives market competitor analysis and the evaluation existing managed care requirements to assess gaps in Humana’s pre-rfp & market entry provider & network strategy.

+ Leads network workstream meetings, including content creation from the market development kick-off through the initiation of the network build.

+ Presents to Medicaid senior leadership regular progress updates on Provider & Network Strategy in assigned markets.

+ Develops provider & network strategies based on insights from the playbook in assigned Medicaid pipeline markets to support RFP responses and market entry.

+ Serves as the market subject matter expert to assist business development in developing provider & network request for proposal (RFP) responses.

Use your skills to make an impact

Required Qualifications

+ Bachelor’s degree

+ 5+ years of experience in network development, contracting, and/or network management or provider relations experience.

+ 2+ years of project leadership experience

+ 2+ years of Medicaid experience/Managed Care

Preferred Qualifications

+ Master’s degree in business administration, healthcare administration, public administration, public health, or public policy.

Work From Home

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 recommended; 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

SSN

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

HireVue

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

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 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.