[Hiring] Director, Network Optimization @Humana

Role Description

The Director, Network Development oversees the strategic development and maintenance of Ohio Medicaid plan's provider network. This senior-level strategist is responsible for driving network optimization and value, while also ensuring compliance with network requirements in the Ohio Department of Medicaid Managed Care Contract. This position reports to the plan's Chief Operating Officer.

• Creates strategy for Ohio Medicaid provider network, including contracting approaches, unique partnerships, and deployment of value-based care models to assure long term mutually successful provider relationships.
• Manages provider network strategic initiatives and tactical execution, ensuring alignment to financial, operational and clinical goals.
• Leads approach and analytics necessary to drive decisions on provider contract renegotiations and terminations.
• Provides market oversight and governance of the management of provider data for the health plan including but not limited to demographics, rates, and contract intent.
• Sets value-based payment strategy, in partnership with key leaders, to ensure compliance with contract requirements.
• Provides market oversight and governance of the management of ODM-required value-based payment models, including but not limited to Comprehensive Primary Care.
• Monitors performance against key performance indicators and contractual commitments and requirements to ensure compliance. Works with health plan leadership to improve performance.
• Participates in operating meetings for key provider relationships to facilitate strategic initiatives and improved performance.
• Works collaboratively with Chief Operating Officer, Provider Services Director, Market Chief Financial Officer, and clinical and quality teams to achieve strategic goals and priorities.

Qualifications

• Bachelor's Degree
• 6+ years of experience working with a managed care organization or as a consultant in a network/contract management role, such as contracting, provider services, etc.
• 2+ years of experience in provider network development, including contracting, network operations, and/or network maintenance.
• 4+ years of experience in value-based contracting models.
• 2+ years of experience in data analysis.
• Proficiency with a wide range of physician/facility/ancillary contract reimbursement methodologies.
• Prior leadership and management experience.
• Ability to manage multiple priorities in a fast-paced environment.
• Experience working in a matrixed organization and influencing change and direction.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

Preferred Qualifications

• Master's Degree
• Experience with the Ohio Medicaid MCO contract, including network adequacy requirements and standards for provider relations compliance.
• Experience with Ohio Medicaid value-based programs, including Pediatric ACO Arrangements, Comprehensive Primary Care, and Comprehensive Maternal Care.

Benefits

• Competitive benefits that support whole-person well-being.
• 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.

Additional Information

• As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue.
• Self-provided internet service must meet minimum criteria: download speed of 25 Mbps and upload speed of 10 Mbps.
• Employees in certain states will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees 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.
• Occasional travel to Humana's offices for training or meetings may be required.

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.

$138,900 - $191,000 per year

This job is eligible for a bonus incentive plan based upon company and/or individual performance.

Company Description

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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.