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

The Provider Services Advisor will be responsible for the strategic and tactical support of the Provider Services team. They will advise the Provider Services Director on the day-to-day and strategic operations of the team, process development and improvement to drive standardization and efficiencies across the team. They will complete related state reports, develop and execute upon a provider communication, and provider materials development strategy. Initially, the Provider Services Advisor will play a key role in supporting new market implementation activities. They will partner cross-functionally within the market and across the enterprise on matters of significance. This Provider Services Advisor exercises independent judgment and decision making on complex issues regarding job duties and related tasks and works under minimal supervision. They use independent judgment requiring analysis of variable factors and determining the best course of action.

Position Responsibilities:

• Advises Provider Services Director on strategic and day-to-day operations of the overall Provider Services team, which includes provider relations, claims education, provider engagement, and provider performance improvement.
• Establishes infrastructure to measure KPIs and other metrics to ensure compliance with related managed care contractual requirements.
• Develops initial and manage annual updates of the market’s Provider Support Plan, in partnership with the Director, as well as any other related required state reporting.
• Oversees provider communications (fax blasts, emails, bulletins, website, or provider portal content updates) end-to-end process, including development of content and management through the approval process.
• Manages provider training and education strategy, including advising on and/or creating market-based provider materials and contributing to provider manual and required training materials.
• Prior to market go-live, contributes to implementation of contractual requirements and day-to-day business processes/functions.
• Leads process development or improvement and communicates them to team members to drive efficiencies, standardization, and best practices for Virginia.
• Drives development of ad-hoc strategic initiatives to execute on the Medicaid Long-Term Services and Support (LTSS)/Home and Community Based Services (HCBS) provider journey, provider relationship management model, and other strategic initiatives.
• Facilitates workgroup calls/meetings/discussions to ensure successful execution of Provider Support Plan.
• Partners with corporate Medicaid Provider Services team to rollout new segment-wide process or technology enhancements in support of the overall Provider Services

Use your skills to make an impact
 

Required Qualifications:

• Bachelor’s Degree.
• 6+ years of related experience, including provider relations or engagement, provider communications and education, and/or related health plan operations
• 2+ years of project management experience
• Experience supporting Government Programs (ie: Medicare/Medicaid, etc)
• Strategic thinker with the ability to identify, prioritize, and solve complex business problems
• Strong attention to detail
• 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
• The applicant must be located in or willing to relocate to Virginia – position may be based at our office in Richmond or remote within the state

Preferred Qualifications:

• Master’s Degree.
• Understanding of managed care contracts, including contract language and reimbursement
• Familiar with LTSS/HCBS providers and/or DSNP/Medicaid-Medicare integration.
• Strong understanding of health plan operations.
• Experience operating in a matrixed environment
• Project management certification.

Additional Information

• This position will be Hybrid/Home along with working in the field
• 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: