Manager Provider Relations

Become a part of our caring community
 Join our growing team as a Manager, Provider Engagement. Reporting to the Director, Provider Engagement, you will lead a team of provider relations associates. You will be responsible for growing positive, long-term relationships with network of LTSS providers in Humana's Dual Fully Integrated and Humana Healthy Horizons plans of Illinois through day-to-day, front-line relationship management.

The Manager, Provider Engagement will:

• Explain and administer company policies/information required for team members to successfully perform their duties
• Train and Educate team on platforms and systems used in everyday work
• Manage teamwork assignments to ensure adequate coverage to meet quality and service levels
• Conduct regular performance evaluation of employees and provide ongoing feedback and coaching as necessary to achieve service, quality, and production goals
• Monitor state standards and guidelines and coordinate interdepartmentally and externally to confirm alignment
• Ensure a solid understanding of Evidenced based Practices programs (ACT, MST, FFT, Homebuilders)
• Ensure prompt responsiveness and appropriate triage of provider inquiries, concerns, or problems, including those associated with claims payment, prior authorizations, and referrals, as well as appropriate education about participation in Humana’s Virginia Medicaid plan
• Work with internal corporate partners to ensure cross-department communication and resolution of provider’s issues
• Work with internal resources and systems (e.g., claims, reimbursement, provider enrollment) to provide the Perfect Experience in all provider interactions with Humana’s Dual Fully Integrated plan of Illinois. Ensure compliance with Illinois’s managed care contractual requirements for provider relations, such as claims dispute resolution within specified timeframes

Use your skills to make an impact
 

Required Qualifications

• Must reside in Illinois
• A Bachelor's Degree is required, accompanied by 4 or more years of progressive experience in managed care operations. This experience should include network management and provider relations.
• Alternatively, a High School Diploma is acceptable, as long as it is paired with 7 or more years of progressive experience in managed care operations, including network management and provider relations.
• 3+ years of experience in Medicaid
• 2+ years of management and team building experience including supervising a staff of at least 5-10 employees
• Experience working for or with key provider types (such as primary care, FQHCs, hospitals, nursing facilities, and/or HCBS and LTSS providers)
• 25% Travel required throughout Illinois

Preferred Qualifications

• Master's Degree
• 1 or more years of contract negotiation and implementation experience
• Experience in and/or understanding of Illinois Medicaid, provider landscape and networks

Additional Information

• Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.
• Typical Work Days/Hours: Monday – Friday, 8:00 am – 5:00 pm CST

Driving

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 100/300/100 limits.

Mileage reimbursement is provided for work-related travel. Eligible mileage includes:

• Travel from your home to your first work location of the day.
• Travel between client or assignment locations during the workday.
• Travel from your final work location back to your home.

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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 will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$86,300 - $118,700 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us
 About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.