Manager, Provider Relations

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🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $86.3k - $118.7k / year

⏰ Full Time

🟠 Senior

🔴 Lead

👔 Manager

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Lead a team of provider relations associates • Grow positive, long-term relationships with LTSS providers in Humana's Illinois plans • Explain and administer company policies and information for team members • Train and educate the team on platforms and systems • Manage team assignments to ensure coverage and quality and service levels • Conduct employee performance evaluations and provide feedback and coaching • Monitor state standards and guidelines and coordinate internally and externally for alignment • Ensure understanding of Evidenced based Practices programs, including ACT, MST, FFT, and Homebuilders • Triage and respond to provider inquiries, concerns, and problems involving claims payment, prior authorizations, and referrals • Educate providers about participation in Humana's Virginia Medicaid plan • Coordinate with corporate partners to resolve provider issues • Use claims, reimbursement, and provider enrollment resources and systems to support provider interactions • Ensure compliance with Illinois managed care contractual requirements, including claims dispute resolution timeframes • Travel throughout Illinois, with 25% travel required

🎯 Requirements

• Must reside in Illinois • Bachelor's Degree with 4 or more years of progressive experience in managed care operations, including network management and provider relations; alternatively, High School Diploma with 7 or more years of such experience • 3+ years of experience in Medicaid • 2+ years of management and team building experience, including supervising 5–10 employees • Experience working for or with primary care providers, FQHCs, hospitals, nursing facilities, and/or HCBS and LTSS providers • 25% travel throughout Illinois • Master's Degree preferred • 1 or more years of contract negotiation and implementation experience preferred • Experience in and/or understanding of Illinois Medicaid, provider landscape, and networks preferred • Valid state driver's license • Proof of personal vehicle liability insurance with at least 100/300/100 limits • Minimum home internet speeds of 25 Mbps download and 10 Mbps upload • Dedicated workspace without ongoing interruptions to protect PHI/HIPAA information • Monday–Friday availability, 8:00 am–5:00 pm CST

🏖️ Benefits

• Bonus incentive plan • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Mileage reimbursement for work-related travel • Remote/home workstyle • Dedicated home workspace arrangement • Home internet service support/requirement for remote work