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Humana Healthy Horizons is a seeking a Senior Project Manager (Medicaid Network Implementation) who is accountable for working with the Director, Network Implementations, Provider Strategy & Operations, to assist with driving efficient management of end-to-end provider-related functions in new Medicaid market implementations. The Senior Project Manager makes decisions supporting technical and operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves processes and performance.

The Senior Project Manager (Medicaid Network Implementation) translates network and provider strategies into tactical plans that can be executed on to ensure timely and successful new market launches and requires an in-depth understanding of how organization capabilities interrelate across the function or segment. The Senior Project Manager directs the timelines, processes, and enterprise readiness to effectively implement network development strategies.

Key Responsibilities:

• Oversee the provider pillar within Medicaid market implementations to ensure timely and accurate delivery of the network build and coordinate with health plan operational functions. This includes network contracting, provider operations, value-based payment, and provider services areas.
• Partner with cross functional and matrixed teams to drive key operational decisions, oversee implementation progress and milestones, and other project management functions.
• Develop and maintain project plan.
• Manage the RAID log (Risk/Issues log for escalations).
• Convene matrixed operational partners to solve for operational gaps/barriers. Solutioning may also include some product development responsibilities, such as developing timelines, process maps, and process flow diagrams in partnership with subject matter experts.
• Lead provider and network implementation preparation, including identifying business owners and subject matter experts in contract shreds, identifying potential business or operational gaps and state nuances.
• Participate in state meetings and share updates with key business and operational partners.
• Support operational readiness preparation, as needed.
• Assist in creating the governance protocols to document and monitor processes, rules, requirements, metrics and performance, and standard operating procedures within division and among shared services partners where relevant.
• Contribute to the implementation of network and provider related contract requirements and RFP commitments to ensure they are on time.
• Plan, organize, monitor, and oversee complex network implementations utilizing matrixed and cross functional teams to deliver defined requirements and meet company strategic objectives.
• Drive process improvements and operational gap closure to improve efficiencies of provider and network implementations.
• Identify and solve problems that impact the management and direction of the business.
• Build and maintain strong internal working relationships at all levels of the organization and across the Enterprise; leverage these relationships in helping to drive innovation and effective operations for Humana Medicaid.

Use your skills to make an impact
 

Required Qualifications

• Must work hours within the Eastern Standard Time Zone.

• Bachelor’s Degree.

• 5+ years of Medicaid managed care, network contracting, network operations, and/or provider relations experience.

• Demonstrated skills in developing and executing strategic playbooks or roadmaps in alignment with organizational goals.

• Proven expertise in driving operational efficiencies and management of timelines and processes.

• Highly adept at managing processes from concept to completion ensuring on-time, on-budget, and on-target results.

• Passion for people development and demonstrated leadership success.

• Ability to identify, structure and solve business problems.

• Excellent interpersonal, organizational, written, and oral communication and presentation skills with proven experience writing and delivering presentations to members of the management team and internal business partners.

Work at Home Requirements

• 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 associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing inte