Network Optimization Professional

Reporting to the Network Optimization Principal, you will play an important role on the Network Optimization team by assisting to ensure compliance with network requirements, including network adequacy, for Humana's Illinois Medicaid plan.

Responsibilities

• Analyze provider network performance by auditing Provider contracts and ensuring Quality Assurance on Provider loading.
• Triage the Provider Escalation tracker and collaborate with departments to manage tasks.
• Analyze internal and external data, and market intelligence information.
• Monitor network adequacy data to inform targeted contracting opportunities and assist the Network Optimization Lead with provider terminations.
• Support the Network Optimization Lead on other responsibilities assigned.

Requirements

• Bachelor's degree with 2+ years of experience in Medicaid managed care operations, provider network contracting, network operations, or network development.
• Candidates without a bachelor's degree may qualify with 3+ years of experience in Medicaid managed care operations, network contracting, network operations, or network development.
• 1 year of experience auditing Provider Contract audits and Quality Assurance of Provider Network loading.
• 2 years of Microsoft Office applications experience (Word, Excel, PowerPoint).
• Reside within the State of Illinois.

Preferred Qualifications

• Familiarity with identifying network issues, ensuring compliance with Illinois Department of Healthcare and Family Services (HFS) requirements, and supporting network operations.
• Ability to run large-scale, visible programs with responsibility for multiple project teams.
• Knowledge of Humana's internal policies and procedures.

Workstyle

• Remote (Home).
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Schedule

• Monday - Friday, 8:00am - 5:00pm Central Standard Time (CST).
• 40 scheduled weekly hours.

Work at Home Requirements

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary.

Travel

While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Pay

• Starting base pay range: $59,300 - $80,900 per year for full time (40 hours per week).
• This job is eligible for a bonus incentive plan based on company and/or individual performance.

Benefits

Humana offers competitive benefits that support whole-person well-being, including:

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave).
• Short-term and long-term disability.
• Life insurance.