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Humana Healthy Horizons is seeking a Lead, Medicaid Provider Services Implementation for new market rollouts across the enterprise who will provide support to assigned health plan and/or specialty companies relative to Medicaid implementation, operations, contract compliance, and federal contract application submissions and works on problems of diverse scope and complexity ranging from moderate to substantial. This Lead role is responsible for creation of and implementation of process and solutions for non-standard contract requirements, and/or resolving complex technical and operational challenges. As a result, this position requires a solid understanding of how organization capabilities interrelate across departments.

The Lead, Medicaid Provider Services Implementation for new market rollout is responsible for standing up provider services functions and other business functions, including people, processes, and tools, in new Medicaid markets in alignment with Medicaid segment standards and contractual requirements.

 

Key Role Objectives and Responsibilities:

·       Responsible for effective and timely implementation of provider services business functions in new Medicaid markets, including but not limited to local market provider services department staffing and standard operating procedure development, development of tailored provider education materials and communications strategy, and development and execution of provider onboarding plan.  

·       Partners cross-functionally on matters of significance to ensure new Medicaid markets deliver best in class provider experiences and are compliant with all related contractual requirements leading up to and upon new Market go live.

·       Assist with hiring of new market Provider Services department leadership and serve as a mentor through post-go-live transition.

·       Facilitates workgroup calls/meetings/discussions for provider services action plan development.

·       Create and manage project plans to ensure effective and timely market rollouts. Prioritize work and escalate risks or barriers as needed.

·       Serve as subject matter expert and provide oversight of development of solutions to relevant non-standard contractual requirements and/or local needs of each Medicaid market.

·       Engage in all new market implementations (at least two simultaneous implementations at any one time), including understanding contract provisions, to support and guide team members on priorities and help them manage risks and escalations.

·       Improve standard operating procedures over time to drive efficiencies and repeatable processes for new market implementations.

·       Cultivate strong working relationships with matrixed organization partners, including operational/shared services areas, needed to support provider services implementations.

Use your skills to make an impact
 

Required Qualifications

• Must work hours within the Eastern Standard Time Zone.
• Bachelor's Degree.
• 3+ years of Medicaid experience.
• 5+ years of experience with health plan operations, provider services, and provider relations.
• 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.
• Exceptional time management and ability to manage multiple priorities in a fast-paced environment.

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 interruptions to protect member PHI / HIPAA information.

Preferred Qualifications

• Master's degree.
• Experience with standing-up new health plan operations and/or implementations.
• Experience with establishing a new team and/or new processes.
• Passionate about contributing to an organization focused on continuously improving provider experiences.

Additional Information

• Travel: None, except for annual meeting at a Humana office location.
• Workstyle: Remote, must work hours within the eastern time zone.
• Core Workdays & Hours: Typically, 8-5 pm Monday – Friday; Eastern Standard Time (EST)
• Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that in