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Network Optimization Lead

Company: Humana
Location: Lima
Posted on: November 26, 2022

Job Description:

DescriptionThe Network Optimization Lead oversees various efforts involving highly complex data analysis and consultation projects/contracts. The Network Optimization Lead works on problems of diverse scope and complexity ranging from moderate to substantial.ResponsibilitiesR-293086 Network Optimization Lead (Medicaid, Network Contracting) RemoteThe Network Optimization Lead, Louisiana Medicaid, is responsible for driving network optimization and value, while also managing compliance with network requirements, including network adequacy, in the Louisiana Department of Health 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. The Lead will integrate data from multiple sources to produce requested or required data elements. 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.Key Responsibilities

  • Contribute to strategy for Louisiana Medicaid provider network, including contracting approaches, unique partnerships, to assure long term mutually successful provider relationships
  • Analyze internal and external data, as well as market intelligence information to inform network operations activities
  • 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
  • Participate and contribute to network governance meetings to proactively identify network issues, ensure compliance with Louisiana Department of Health 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
  • Help to create and maintain network dashboard
  • Work collaboratively with Chief Operating Officer, Provider Services Director, health plan finance, and clinical and quality teams to achieve strategic goals and prioritiesR-293086 Network Optimization Lead (Medicaid, Network Contracting) RemoteRequired Qualifications
    • Bachelor's Degree
    • 5+ years of experience in Medicaid managed care operations, network contracting, network operations and/or network development
    • Expertise in assessing complex data sets and performing root cause analysis
    • 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
    • In-depth experience in Microsoft Excel including formulas, pivots, charts, graphs, etc.
    • 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.
    • Must be passionate about contributing to an organization focused on continuously improving consumer experiencesPreferred Qualifications
      • Master's Degree
      • Understanding of Louisiana Department of Health contractual requirements, and provider landscape
      • 1+ year of experience in SQL, SAS, or other data systems
      • Knowledge of Humana's internal policies, procedures, and systemsAdditional information
        • Schedule: 8 am to 5 pm CST Monday through Friday with the flexibility to work weekends, holidays and/or mandatory overtime based on business needs
        • Training: Online Training - 1 Week
        • Work Location (Address): Work at Home/Remote - Nationwide
        • # of Direct Reports: TBD#LI-Remote#LI-EM1Scheduled Weekly Hours40Humana 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 https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Keywords: Humana, Fort Wayne , Network Optimization Lead, Other , Lima, Indiana

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