Network Optimization Lead OH Medicaid - Remote Ohio

Profile

Job Information

Humana

Network Optimization Lead (OH Medicaid) - Remote, Ohio

in

Cleveland

Ohio

Description

The Network Optimization Lead, Ohio Medicaid, is responsible for driving network optimization and value, while also managing compliance with network requirements, including network adequacy, in the Ohio Department of Medicaid Managed Care Contract. The Lead will support the analysis of provider network performance to inform contracting and terminations, work closely with the Provider Relations team to understand and address network operational issues, and advise on network composition and value-based payment strategy. This position works on problems of diverse scope and complexity ranging from moderate to substantial. This is a collaborative role requiring critical thinking and problem solving skills, independence, tactical execution on strategy, and attention to detail. This position reports to the Director, Network Optimization.

Responsibilities

Contribute to strategy for Ohio Medicaid provider network, including contracting approaches, unique partnerships, and deployment of value-based care models to assure long term mutually successful provider relationships.

Analyze internal and external data, as well as market intelligence information.

Monitor network adequacy data to inform targeted contracting opportunities and manage resolution process in the event of network terminations.

Manage provider network strategic initiatives and their tactical execution, ensuring alignment to financial, operational and clinical goals.

Lead network governance meetings to proactively identify network issues, ensure compliance with Ohio Department of Medicaid requirements, and support network operations.

Monitor performance against key performance indicators and contractual commitments and requirements to ensure compliance. Work with health plan leadership to drive operational efficiencies and improve performance.

Solve complex business challenges.

Work collaboratively with Chief Operating Officer, Provider Services Director, health plan finance, and clinical and quality teams to achieve strategic goals and priorities.

Required Qualifications

Bachelor's Degree.

4 years of experience in Medicaid managed care operations, network contracting, network operations and/or network development.

Must reside in the state of Ohio.

Demonstrated skills in executing on strategic playbooks or roadmaps in alignment with organizational goals.

Proven expertise in driving operational efficiencies and management of timelines and processes. Highly adept at managing processes from concept to completion ensuring on-time, on-budget, and on-target results..

Ability to identify, structure and solve complex business problems.

Experience operating in matrixed environment.

Excellent interpersonal, organizational, written, and oral communication and presentation skills with proven experience writing and delivering presentations to members of the management team.

This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.

Must have a separate room with a locked door that can be used as a home office, to ensure you have absolute and continuous privacy while you work.

Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.

For this job, associates are required to be fully COVID vaccinated or

undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.

If progressed to offer, you will be required to: Provide proof of full vaccination OR

Commit to weekly testing, following all CDC protocols, OR

Provide documentation for a medical or religious exemption consideration. This policy will not supersede state or local laws. Requests for these exemptions should be submitted at least 2 weeks prior to your scheduled first day of work.

Preferred Qualifications

Master's Degree.

Experience working with the Ohio Department of Medicaid (ODM) contracting requirements.

Understanding of Ohio Medicaid contractual requirements, Ohio Administrative and Revised Codes, and provider landscape.

Expertise in value based payment models.

Knowledge of Humana's internal policies, procedures and systems.

Additional Information

Workstyle:

Hybrid Home

Travel:

Up to 20%

Scheduled Weekly Hours

40

Company info

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