Lead, Medicaid Provider Services Implementation

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 Humana Healthy Horizons is seeking a Lead, Medicaid Provider Services Implementation, for new market rollouts across the enterprise who will provide support to assigned health plan and specialty companies relative to Medicaid implementation, operations, contract compliance, and federal contract application submissions.

The Lead, Medicaid Provider Services Implementation role is responsible for the creation and implementation of processes and solutions for non-standard contract requirements and resolving of complex technical and operational challenges. As a result, the Lead position requires a solid understanding of how organization capabilities interrelate across departments to work on problems of diverse scope and complexity ranging from moderate to substantial.

The Lead, Medicaid Provider Services Implementation, for new market rollout is responsible for standing up provider services functions and other business functions, including people, processes, and tools, in new Medicaid markets in alignment with Medicaid segment standards and contractual requirements.

 

Key Role Objectives and Responsibilities:

• Responsible for effective and timely implementation of provider services business functions in new Medicaid markets, including but not limited to local market provider services department staffing and standard operating procedure development, development of tailored provider education materials and communications strategy, and development and execution of provider onboarding plan.  
• Partners cross-functionally on matters of significance to ensure new Medicaid markets deliver best in class provider experiences and are compliant with all related contractual requirements leading up to and upon new Market go live.
• Assists with hiring of new market Provider Services department leadership and serve as a mentor through post-go-live transition.
• Facilitates workgroup calls/meetings/discussions for provider services action plan development.
• Creates and manages project plans to ensure effective and timely market rollouts. Prioritize work and escalate risks or barriers as needed.
• Serves as subject matter expert and provide oversight of development of solutions to relevant non-standard contractual requirements and/or local needs of each Medicaid market.
• Engages in all new market implementations (at least two simultaneous implementations at any one time), including understanding contract provisions, to support and guide team members on priorities and help them manage risks and escalations.
• Improves standard operating procedures over time to drive efficiencies and repeatable processes for new market implementations.
• Cultivates strong working relationships with matrixed organization partners, including operational/shared services areas, needed to support provider services implementations.

Use your skills to make an impact
 

Required Qualifications

• Must work hours within the Eastern Standard Time Zone.
• Bachelor's Degree.
• 3+ years of Medicaid experience.
• 5+ years of experience with health plan operations, provider services, and provider relations.
• 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 with standing-up new health plan operations and/or implementations.
• Experience with establishing a new team and/or new processes.
• Passionate about contributing to an organization focused on continuously improving provider experiences.

Additional Information

• Travel: None, except for 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 Hire Vue, 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 will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$93,000 - $128,000 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 veteran status. 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.

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