Senior Network Optimization Professional Ohio Medicaid

Profile

Description

Humana Healthy Horizons in Ohio is seeking a Senior Network Optimization Professional who will oversee various efforts involving network operations processes and governance. The Senior Network Optimization Professional works assignments involving moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

Drives network optimization and value through network contracting governance, process development, and data governance Ohio Medicaid, including developing contracting requirements, internal reporting compliance processes and supporting data integrity as required in the Ohio Medicaid Provider Agreement.

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.

Required Qualifications

Bachelor's Degree or equivalent experience.

3 years of provider network contracting or provider data management experience.

2 years of process creation or improvement experience.

Proficient in MS Office Applications including SharePoint, Teams, MS Word, PowerPoint, Outlook, and Excel.

Proficiency at achieving results within a highly matrixed organization.

Strong knowledge of provider network operations tools, processes, and best practices.

Ability to manage and prioritize multiple projects.

Excellent written and verbal communication skills.

Must have the ability to provide a high speed DSL or cable modem for a home office.

A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

Satellite and Wireless Internet service is NOT allowed for this role.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Preferred Qualifications

Master's Degree.

Strong familiarity with Medicaid, 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.

Additional Information

Workstyle: Remote but flexible for associate to work a Hybrid Home or Hybrid Office workstyle in Humana Healthy Horizon's Dublin, OH location.

Travel: Less than 10% to office meetings in Dublin, OH.

Typical Work Days/Hours: Monday - Friday; 8:30am - 5:00pm

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 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

Company info

Humana Inc.
Website : http://www.humana.com