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

The Behavioral Health Network Operations Lead will be the Subject Matter Expert on Ohio Medicaid Behavioral Health. Responsibilities will include maintaining provider relations to support customer service activities through data integrity management. Communicates contract terms, payment structures, and reimbursement rates to providers. Analyzes financial impact of contracts and terms. Maintains contracts and documentation within a tracking system. Identifies and recruits providers based on network composition and needs. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks and works under minimal supervision. Uses independent judgment requiring analysis of variable factors and determining the best course of action.

The Behavioral Health Network Operations Lead manages behavioral health provider data for health plans including but not limited to adequacy, accessibility, demographics, rates, and contract intent. Manages provider audits, provider service and relations, credentialing, and contract management systems. Executes processes for intake and manage provider perceived service failures, including response to state inquiries and provider/member complaints. Drives to root cause and subsequent resolution with significant engagement with internal departments.  Works closely with the Ohio Medicaid market operational leadership team to ensure regulatory adherence, process improvement, and reduction in provider friction points.  Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks and works under minimal supervision. Uses independent judgment requiring analysis of variable factors and determining the best course of action.

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

• Health benefits effective day 1
• Paid time off, holidays, volunteer time and jury duty pay
• Recognition pay
• 401(k) retirement savings plan with employer match
• Tuition assistance
• Scholarships for eligible dependents
• Parental and caregiver leave
• Employee charity matching program
• Network Resource Groups (NRGs)
• Career development opportunities

Use your skills to make an impact
 

Required Qualifications

• 3+ years of experience with behavioral health provider contracting

• Experience working directly with entities such as Community Mental Health Centers, Psychiatric Acute/Residential Facilities, and Medication Assisted Treatment

• Experience with analyzing, understanding, and communicating financial trends

• Strong process orientation and experience implementing process improvement initiatives

• Intermediate knowledge of Microsoft Word and Excel

• Must reside within reasonable driving distance to the state of Ohio

Preferred Qualifications

• Bachelor's Degree

• Understanding of Medicaid regulatory compliance

• Experience working in a people leadership role

• Experience with credentialing and contract management systems

Additional Information

This position will be remote, but candidates must live within reasonable driving distance to the state of Ohio as you may be required to travel occasionally within the region.

Work-At-Home Requirements

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