Sr. Professional Network Strategy

Become a part of our caring community and help us put health first
 The Senior Professional Provider Network Strategy will be accountable for supporting the development of Humana Healthy Horizon’s Medicaid network strategy and market approaches in the Medicaid growth pipeline states. This network strategist will provide research driven advisement to support the development of adequate and accessible networks and market specific provider network approaches to advance market entry.

The Senior Professional will also facilitate the development and or enhancement of team and department strategies and operational procedures. The position requires experience with synthesizing and evaluating multiple sources of qualitative and quantitative information to inform network market entry priorities and positioning. Additionally, this position requires an in-depth understanding of how organizational capabilities interrelate within the enterprise to develop and execute on network strategy.

The Senior Professional Provider Network Strategy roles and responsibilities include:

• Conducts discovery research and analysis of regulatory network and provider requirements to inform the Humana Medicaid Growth Market Network Strategic Plan, under the guidance of the Strategy Advancement Advisor.

• Project manages the development of provider and network market entry strategy and approaches among the Medicaid Value Based and Provider Solutions department leadership.

• Supports the development of provider and network Request for Proposal (RFP) responses to advance Humana’s Medicaid growth strategy in new and rebid markets.

• Facilitates the development, documentation, and periodic updates of team operational process and procedure documents.

• Evaluates teams processes and supports to business areas and developments and implements actions plans to solution for identified opportunities.

• Assesses health plan provider network operations of market entry regulatory requirements and plan commitments to inform market RFP rebid approach.
• Exercises independent judgment and decision making on complex issues regarding job duties and related tasks requiring analysis of variable factors and determining the best course of action and works under minimal supervision.

Use your skills to make an impact
 

Required Qualifications

• Bachelor's degree.
• 3 + years of experience researching and interpreting CMS, state Medicaid, and other quantitative and quality regulatory sources.
• 2+ years of project leadership experience.
• 2+ years of Medicaid experience.
• Strong comprehension of federal and or state Medicaid provider network regulations and requirements and health plan network operations.

Preferred Qualifications

• Master’s degree in business administration, healthcare administration, public administration, public health, or public policy.

Work From Home

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid …