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The Network Optimization Principal oversees various efforts involving highly complex data analysis and consultation projects/contracts. The Network Optimization Principal provides strategic advice and guidance to functional team(s). Highly skilled with broad, advanced technical experience.

Role Overview

The Network Optimization Principal oversees the strategic development and maintenance of the Michigan HIDE SNP plan provider network. This senior-level strategist is responsible for driving network optimization and value, while also ensuring compliance with network requirements in the Michigan Managed Care Contract. The Principal will analyze provider network performance to inform contracting and terminations, partner with the Provider Relations team to understand and address network operational issues, and advise on network composition, and value-based payment strategy. This is a collaborative role requiring critical thinking and problem-solving skills, independence, leadership, a strategic mindset, and attention to detail. This position reports to the plan’s Chief Operations Officer.

Position Responsibilities

• Develop and implement network strategies to ensure access, adequacy, and high-value care aligned with organizational goals.
• Maintain and update the network development plan annually. Serve as subject matter expert on Michigan network standards, compliance, and provider crosswalk/mapping to ensure accurate state data submissions.
•  Identify and address Medicaid network adequacy risks and target provider recruitment to close gaps.
• Oversee ad-hoc contracting, value-added and in-lieu-of service assessments, and provider data accuracy, coordinating with relevant departments.
• Ensure timely state-required submissions for incurable gaps and terminations, and monitor network adequacy impacts from provider terminations.
• Manage member and provider communications, maintain tracking systems, and oversee approvals for non-standard FFS or VBP rate requests.
• Develop strategies and governance for Michigan value-based payment (VBP), review new arrangements, and pursue contract renegotiation to address trends.
• Oversee VBP model management, monitor performance against KPIs, ensure compliance, and collaborate with leadership and cross-functional teams to drive improvements and advance strategic initiatives.

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s Degree or equivalent experience of 10 years
• 6+ years’ experience working with a managed care organization or as a consultant in a network/contract management role, such as contracting, provider services, etc.
• 2+ years of experience in provider network development, including contracting, network operations, and/or network maintenance.
• 4+ years of experience in value-based contracting models.
• 2+ years of experience in data analysis.
• Proficiency with a wide range of physician/facility/ancillary contract reimbursement methodologies. 
• Prior leadership and management experience.
• Ability to manage multiple priorities in a fast-paced environment.
• Experience working in a matrixed organization and influencing change and direction.

Preferred Qualifications

• Master’s Degree.
• Experience with the Michigan Medicaid/Dual, including network adequacy requirements and standards for provider relations compliance.
• Experience building teams from the ground up in a fast-paced implementation environment.

Additional Information

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 required; wireless, wired cable or DSL connection is required.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• 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.

Social Security Number Statement

Humana value's personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it