Associate Director, Medicaid Provider Services

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 Humana Healthy Horizons is seeking an Associate Director, Medicaid Provider Services to serve in a strategic leadership role within Humana’s Corporate Medicaid segment. The Medicaid Provider Services team, led by the Associate Director, is accountable for Humana’s Medicaid segment strategy and operationalizing the operational strategy related to provider relations, provider performance improvement, and network management. This leader will work closely with Medicaid markets to stand up their related staffing, processes, and tools to ensure compliance with contractual requirements and foster effective Market operations and positive provider experiences.

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. This leader should have prior experience working in these business areas for a health plan and expertise in setting and executing on strategy, developing and leading teams, and working in matrixed environments.

The Associate Director, Medicaid Provider Services Key Role Objectives:

• Lead 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.
• Oversee 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.
• Oversee the Provider Support Model associated with implementation and operations of Provider Relationship Management model.
• Drive development of operational processes, trainings, and KPIs to execute on the Medicaid Provider Relationship Management model, and other strategic initiatives.
• Develop and implement 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).  
• Assist with hiring of new market Provider Services department leadership and serve as a mentor through post-go-live transition.
• Serve as segment’s subject matter expert on provider relations and provider engagement/performance improvement.
• Provide oversight of development of solutions …