Vacancy expired!
DescriptionThe Contract Tools, Education, Processes Professional 2 builds templates, standard documentation, policy and protocol, case studies, and disseminating best in class knowledge. The Contract Tools, Education, Processes Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.ResponsibilitiesThe Professional 2, Contracting Tools, Education and Process role for Medicaid Network Implementaion assists as needed to ensure the full range of network requirements are met for the Network Expansion and Optimization division of National Network Operations. The Professional 2 provides internal support to Provider Network by following through all tasks related to provider operations. Functions include but are not limited to helping facilitate the business development team, coordinate with the markets and provider service organization to ensure that the network is fully implemented within the RFP and state provider network requirements.Responsibilities:
Reviews state Medicaid RFP for special network requirements that may have an impact to Humana’s standard policies and procedures and other National Network Operations processes.
Collaborates with the market/compliance/and business partners as needed to create policies and procedures, including initial letters for readiness review for subjects managed by network contracting and provider market operations.
Assists in duties related to each assigned expansion market examples include collection of any state or loading and credentialing required documentation, research and obtain as needed missing provider data, monitor the progress and completion of network conversion, loading and credentialing.
Creates and submits required provider survey reports as assigned per process outlined by leadership and approved by compliance.
Updates any document previously approved by state if amended by state after initial creation.
Meets all deliverables within the timelines and requirements.
Works together with Medicaid MSO team to ensure project success. Completes other special projects and duties as requested.
Required Qualifications
Bachelor's Degree in Business, Healthcare Administration, Mathematics and/or related field
2+ years of provider network implementation technical experience
Healthcare and/or managed care experience
Solid experience carrying out network implementation project plans
Possesses a solid understanding of how organization capabilities interrelate across department(s)
Ability to handle mid scale projects
Clear oral and written communication skills
Flexible, dynamic personality who works well in a team environment
Preferred Qualifications
Master's degree in Business and/or related field
Medicaid experience strongly preferred
Experience writing and editing policies and procedures
Experience reviewing provider manuals
Scheduled Weekly Hours40About UsMission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first. Equal Opportunity EmployerIt is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailboxtasrecruit@humana.com for assistance.Humana Safety and SecurityHumana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact mailboxtasrecruit@humana.com to validate the request.
Vacancy expired!