Sr. Professional Medicaid Network Strategy Remote

Profile

Description

The Senior Professional, Medicaid Network Strategy will be accountable for supporting the development of Humana Healthy Horizon's (Medicaid) network and provider strategy for its growth markets. This strategist will provide data-driven and research oriented strategic direction to the development of adequate and accessible networks, sound go-to-market and request for proposal (RFP) strategy related to access to care, provider relations, and value-based purchasing. The Senior Professional also supports of multi-functional efforts to identify, interpret, and produce network build plans based on company and external data analysis. The position requires an in-depth understanding of how organizational capabilities interrelate within the enterprise in order to develop and execute on network strategy. This position exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, uses independent judgment requiring analysis of variable factors and determining the best course of action.

Responsibilities

Key Responsibilities


Accountable for providing data and research driven input and support to guide growth market network builds, value-based payment, provider relations strategy, and provider network operations.
Contribute to the development of a provider network strategy playbook for growth markets through targeted research of state regulatory and policy provider network requirements.
Work cross functionally with internal business area subject matter experts to conduct operational assessments on growth market state managed care rfp and scope of work requirements (including but not limited to, network adequacy, credentialing, provider relations and education, and value-based payment/provider incentives) in comparison to the Humana standard operating model.
Conduct gap analysis from operational assessments to assist the Medicaid network and partner business areas in making strategic decisions on provider network operations.
Collect, analyze, and synthesize data from internal and external sources to support provider network strategy operations
Inform Medicaid request for proposal (RFP) responses related to providers in alignment w/ segment goals and network development playbooks


Required Qualifications


Bachelor's degree
Experienced strategist with strong track record of synthesizing and evaluating multiple sources of qualitative and quantitative data to define network priorities and build solutions
2 years of Medicaid experience
5 years of experience in Health Care or managed care with Provider Contracting, Network Contracting, Network Management or Provider Relations Experience
1 year of project leadership experience
Proven ability to interpret and utilize competitive intelligence, state regulatory and contractual requirements, and financial analyses to inform strategy
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


Preferred Qualifications


Master's Degree
Must be passionate about contributing to an organization focused on continuously improving consumer experiences


Additional Information

Work-At-Home Requirements

WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

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

COVID POLICY

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.

Scheduled Weekly Hours

40

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 ****

Company info

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