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Humana Healthy Horizons is seeking an Associate Director, Medicaid Provider Services to oversee a team that develops and executes on Humana Medicaid segment’s provider services strategy ensuring that network providers deliver optimal provider experiences and promote provider performance. This dynamic leader will also lead a team that deploys provider services business functions, including people, processes, and tools, in new Medicaid markets in alignment with Medicaid segment standards and contractual requirements.

The Associate Director partners cross-functionally on matters of significance to enable Medicaid markets to deliver best in class provider experiences that complies with all related contractual requirements. Decisions are typically related to setting clear expectations for associates, developing strategic plans, implementing processes and procedures, and/or resolving complex technical and operational challenges. The Associate Director role requires an in-depth understanding of how organization capabilities interrelate across the function or segment, critical thinking/problem solving skills, a strategic mindset, and attention to detail.

The Associate Director, Medicaid Provider Services Key Role Objectives:

• Leads a dynamic and agile team responsible for developing and enhancing Humana Medicaid’s standard Provider Support strategy and implementing standard and tailored Provider Support Model solutions in new Medicaid markets.
• Oversees the strategic development, delivery, and ongoing refinement of Humana Medicaid Provider Support Model to drive optimal provider experience and performance in alignment with organizational goals.
• Oversees the Provider Support Model associated with implementation and operations of Provider Relationship Management model.
• Drives development of operational processes, trainings, and KPIs to execute on the Medicaid Provider Relationship Management model, and other strategic initiatives.
• Develops and implements various standards, resources, tools, and best practices sharing across the organization.
• Accountable for team’s effective and timely implementation of provider services business functions in new Medicaid markets in alignment with Humana Medicaid standards and tailored to local market nuances and contractual requirements. Provider services functions include but not limited to local market provider relations, provider performance, and claims education staffing, standard operating procedure development, tailored provider education materials development, and provider onboarding plan development and execution.
• Assists with hiring of new market Provider Services department leadership and serve as a mentor through post-go-live transition.
• Serves as segment’s subject matter expert on provider relations and provider engagement/performance improvement.
• Provides oversight of development of solutions to relevant non-standard contractual requirements and/or local needs of each Medicaid market.
• Assists with strategy development and staffing plans for new market requests for proposal (RFP).
• Defines and maintains team strategic priorities, scope of work, roles and responsibilities, and policies and standard operating procedures for associates.
• Sets clear goals, expectations, and roles and responsibilities for team members. Support Director with resource planning and market assignments to team members.
• Improves standard operating procedures over time to drive efficiencies and repeatable processes.
• Cultivates strong working relationships with matrixed organization partners, including operational/shared services areas, needed to support provider services implementations and operations.
• Supports team members to be successful in their roles, including regular 1:1s, semi-annual performance reviews, and performance coaching, as needed, to ensure positive work environment that promotes associate retention and high-quality work products.

Use your skills to make an impact

Required Qualifications

• Must work hours within the Eastern Standard Time Zone.
• Bachelor's Degree.
• 6+ years of progressive leadership experience.
• 7+ years of experience in provider relations, provider engagement and/or claims education at a health plan.
• Experience and understanding of Medicaid.
• Experience with defining strategic vision for team and developing standard operating procedures, priorities, and associate expectations to execute on that vision.
• 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.
• Exceptional time management and ability to manage multiple priorities in a fast-paced environment.

Work at Home Requirements

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Preferred Qualifications

• Master's Degree.
• Experience standing up new health plan operations and/or implementations.
• Experience with establishing a new team and/or new processes.
• Behavioral health or LTSS experience.
• Passionate about contributing to an organization focused on continuously improving provider experiences.

Additional Information

• Direct Reports: 4 current direct reports.
• Travel : None, except for possible annual meeting at a Humana office location.
• Workstyle: Remote, must work hours within the eastern time zone.
• Core Workdays & Hours: Typically, 8-5 pm Monday – Friday; Eastern Standard Time (EST)
• Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more.....

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

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$112,400 - $154,900 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.