Become a part of our caring community and help us put health first
 

The Manager, Provider Services – PCP/Medical leads a team of provider relations associates responsible for growing positive, long-term relationships with network PCP/Medical providers in Humana’s Healthy Horizons Virginia Medicaid plan through day-to-day, front-line relationship management. The Manager is responsible for facilitating a positive provider relationship management experience, through provider training, education, responding to provider inquiries, and resolving issues or complaints. Understands key internal systems that support the provider experience. This individual identifies and leads opportunities to make changes to improve operations across teams and works on general matters in which analysis of issues, data and processes require evaluation of multiple factors.

• Explain and administer company policies/information required for team members to successfully perform their duties
• Train and Educate team on platforms and systems used in everyday work
• Manage teamwork assignments to ensure adequate coverage to meet quality and service levels
• Conduct regular performance evaluation of employees and provide ongoing feedback and coaching as necessary to achieve service, quality, and production goals
• Monitor state standards and guidelines and coordinate interdepartmentally and externally to confirm alignment
• Ensure a solid understanding of Evidenced based Practices programs (ACT, MST, FFT, Homebuilders)
• Ensure prompt responsiveness and appropriate triage of provider inquiries, concerns, or problems, including those associated with claims payment, prior authorizations, and referrals, as well as appropriate education about participation in Humana’s Virginia Medicaid plan
• Work with internal corporate partners to ensure cross-department communication and resolution of provider’s issues
• Work with internal resources and systems (e.g., claims, reimbursement, provider enrollment) to provide the Perfect Experience in all provider interactions with Humana’s Virginia Medicaid plan
• Ensure compliance with Virginia’s managed care contractual requirements for provider relations, such as claims dispute resolution within specified timeframes

Use your skills to make an impact
 

Required Qualifications 

• Bachelor’s Degree with 4+ years of progressive experience in managed care operations, including network management and provider relations OR 7+ years of progressive experience in managed care operations, including network management and provider relations
• Experience working for or with key provider types (such as primary care, FQHCs, hospitals, nursing facilities, and/or HCBS and LTSS providers)
• 2+ years of management and team building experience including supervising a staff of at least 5-10 employees
• Proven planning, preparation and presenting skills
• Demonstrated ability to manage multiple projects and meet deadlines.
• Exceptional relationship management skills
• Prior experience working in and strong understanding of Medicaid
• Ability to manage multiple priorities in a fast-paced environment
• Knowledge of Microsoft Office applications
• Ability to travel as needed throughout Virginia

Preferred Qualifications

• Master’s Degree
• Contract negotiation and implementation experience

Additional Information

• This position will be remote
• This role is a part of Humana’s Driver Safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.

Work at Home Criteria

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• 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 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.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base