at Humana in Springfield, Illinois, United States
Job Description
Become a part of our caring community and help us put health first
Humana is seeking a Manager, Long Term Care (LTC) Non-Residential Provider Contracting who will be responsible for the oversight of the network development LTC non-residential contracting teams in the Wisconsin Medicaid market.
The Manager, LTC Non-Residential Provider Contracting communicates contract terms, payment structures, and reimbursement rates to providers, analyzes financial impact of contracts and terms, and maintains contracts and documentation within a tracking system. This position also identifies and recruits providers based on network composition and needs.
+ Support and contribute to the development of a strategic plan to meet LTC provider network business objectives, including the development and ongoing evaluation of the quality and adequacy of the network.
+ Position company for achieving NCQA designation for Long Term Care programs.
+ Represent, communicate and advocate the company mission to current and/or prospective participants in the LTC provider network to ensure delivery of quality care for populations served.
+ Identify opportunities (including programmatic methods, techniques, supports, etc.) to add value to provider relationships that improve their satisfaction with affiliation and the effectiveness of the LTC plans.
+ In collaboration with Provider Relations and Quality Departments, transmit to providers through contractual, instructional, and educational materials and instruments (e.g., contracts, provider manual, presentations, alerts, report cards, etc.) responsibilities, commitments, and methods for achieving quality performance requirements as specified in their contract.
+ Build and maintain positive working relationships with current and prospective provider communities to protect and enhance goodwill.
+ Review, analyze and recommend further provider network development or adjustment whenever these changes might result in a sustained competitive advantage for the company.
+ Assist with the expansion and diversification of WI Medicaid lines of business within existing and new market areas as such expansion plans are approved by executive management.
+ Assume appropriate leadership in all instances that involve development of the provider network for long term care.
+ Ensure the provider network meets the compliance standards that are contained in WI Medicaid contracts with State and Federal governments.
+ Coordinate with the credentialing area to ensure that the provider network is properly credentialed and oriented toward achieving state and federal contract performance requirements.
+ Collaborate with the finance department to apply contracted rate structures assumed in budgeted medical loss ratios, to analyze trends in provider claims performance over time and to achieve the financial performance objectives of the company.
+ Collaborate with other departments as needed to support overall member and provider experience and outcomes (e.g. Care Management, Prior Authorization, Claims, Grievance and Appeal).
+ Supervise and develop contracting support staff as peak performers in a multi-dimensional effort to achieve network development objectives.
+ Participate in internal and external workgroups, committees and associations that pertain to provider network development.
+ Prepare, review, and/or enforce policies and procedures that pertain to management of the LTC provider network.
Use your skills to make an impact
Required Qualifications
+ Bachelor’s Degree
+ 3-5 years of provider contracting and network development experience in a managed care or health insurance environment.
+ 2 or more years of management experience including supervising and team building.
+ Experience analyzing and interpreting financial trends in the provider contracting arena.
+ Experience preparing contracts, with an in-depth knowledge of Medicaid and other reimbursement methodologies.
+ Proficiency with all Microsoft applications
Preferred Qualifications
+ Master’s Degree
Additional Information
+ Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.
+ Location: must reside within WI or contiguous state (MN, IA, IL).
+ Travel: up to 20% within the state of WI.
+ Typical Work days/hours: Monday – Friday, 8:00 am – 5:00 pm Central Standard Time (CST).
+ Direct Reports: approximately 8 direct reports.
WAH Internet 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 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.
Benefits
Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including:
+ Health benefits effective day 1
+ Paid time off, holidays, volunteer time and jury duty pay
+ Recognition pay
+ 401(k) retirement savings plan with employer match
+ Tuition assistance
+ Scholarships for eligible dependents
+ Parental and caregiver leave
+ Employee charity matching program
+ Network Resource Groups (NRGs)
+ Career development opportunities
HireVue
As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire 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.
Limited Geography Remote – This is a remote position but located within a specific geography.
\#LI-JP1
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.$93,000 – $128,000 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
About Inclusa: Inclusa manages the provision of a person-centered and community-focused approach to long-term care services and support to Family
To view full details and how to apply, please login or create a Job Seeker account