Network Optimization Professional

Job not on LinkedIn

🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $59.3k - $80.9k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

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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

• Analyze provider network performance by auditing provider contracts • Ensure quality assurance on provider loading • Triage the provider escalation tracker • Collaborate with departments to manage tasks • Analyze internal and external data and market intelligence • Monitor network adequacy data to inform targeted contracting opportunities • Assist the Network Optimization Lead with provider terminations • Support the Network Optimization Lead with other assigned responsibilities • Help ensure compliance with network requirements for Humana’s Illinois Medicaid plan

🎯 Requirements

• Bachelor's degree with 2+ years of experience in Medicaid managed care operations, provider network contracting, network operations, or network development • Candidates without a bachelor's degree may qualify with 3+ years of experience in Medicaid managed care operations, network contracting, network operations, or network development • 1 year of experience auditing provider contracts and performing quality assurance of provider network loading • 2 years of experience with Microsoft Office applications, including Word, Excel, and PowerPoint • Reside within the State of Illinois • Familiarity with identifying network issues and ensuring compliance with Illinois Department of Healthcare and Family Services requirements (preferred) • Ability to run large-scale, visible programs with responsibility for multiple project teams (preferred) • Knowledge of Humana's internal policies and procedures (preferred) • Minimum 25 Mbps download speed and 10 Mbps upload speed for home internet • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information

🏖️ 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 • Self-provided internet service for home work • Remote home work arrangement