Manager, Provider Engagement

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

Humana Gold Plus Integrated is seeking a Manager of Provider Engagement who leads a team of provider relations professionals responsible for growing positive, longterm relationships with network PCPMedical providers in Humana’s Dual Fully Integrated plan of Illinois through daytoday, frontline relationship management.

The Manager is responsible for facilitating a positive provider relationship management experience through provider training, education, responding to provider inquiries, and resolving issues or complaints by understanding key internal systems that support the provider experience.

The Manager of Provider Engagement roles and responsibilities include:

• Explain and administer company policiesinformation required for team members to successfully perform their duties.
• Train and educate team on platforms and systems used in everyday work.
• Manage teamwork assignments to ensure adequate coverage to meet quality and service levels.
• Conduct regular performance evaluation of associates and provide ongoing feedback and coaching as necessary to achieve service, quality, and production goals.
• Monitor state standards and guidelines and coordinate interdepartmentally and externally to confirm alignment.
• Ensure a solid understanding of Evidenced based Practices programs (ACT, MST, FFT, Homebuilders).
• Ensure prompt responsiveness and appropriate triage of provider inquiries, concerns, or problems, including those associated with claims payment, prior authorizations, and referrals, as well as appropriate education about participation in Humana’s Illinois Medicaid plan.
• Work with internal corporate partners to ensure crossdepartment communication and resolution of provider’s issues.
• Work with internal resources and systems (e.g., claims, reimbursement, provider enrollment) to provide the Perfect Experience in all provider interactions with Humana’s Dual Fully Integrated plan of Illinois. Ensure compliance with Illinois’s managed care contractual requirements for provider relations, such as claims dispute resolution within specified timeframes.

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  Use your skills to make an impact
  

  Required Qualifications

  • Must live in (or be willing to relocate) to the State of Illinois and be able to travel throughout Illinois as needed for role.
  • Bachelor’s Degree with 4 or more years of progressive experience in managed care operations, including network management and provider relations OR equivalent work experience with 7 or more years of progressive experience in managed care operations, including network management and provider relations.
  • Experience working for or with key provider types (such as primary care, FQHCs, hospitals, nursing facilities, andor HCBS and LTSS providers).
  • 2+ years of management and team building experience including supervising a staff of at least 510 employees.
  • Prior experience working in and strong understanding of Illinois Medicaid, provider landscape and networks.
  • Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies.
  • Demonstrated ability to manage multiple prioritiesprojects in a fastpaced environment to meet deadlines.
  • Experience working in a matrixed organization and influencing change and direction.
  • Intermediate to advanced knowledge of Microsoft Suite applications, specifically Word, Excel, Outlook, and PowerPoint.
  • Exceptional relationship management and collaboration skills.
  • 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 100,000300,000100,000 limits.

  • Preferred Qualifications

    • Master’s degree.
    • Contract negotiation and implementation experience
    • Comprehensive knowledge of Medicare policies, processes, and procedures.

    • 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.
      • Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided with a biweekly payment for their internet expense.
      • Humana will provide Home or Hybrid HomeOffice associates with telephone equipment appropriate to meet the business requirements for their positionjob.
      • Work from a dedicated space lacking ongoing interruptions to protect member PHI HIPAA information.

      • Additional Information

        • Direct Reports: Up to 10 associates.
        • Workstyle: Remote – work at home; must live in the State of Illinois.
        • Travel: Up to 50% travel in the field across the state of Illinois.
        • Core Workdays & Hours: Typically, 85 pm Monday – Friday Central Standard Time (CST) with flexible scheduling (i.e. occasional nights and weekends).
        • Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more.....

        • Interview Format

          As part of our hiring process, we will be using exciting interviewing technology provided by Hire Vue, a thirdparty vendor. This technology provides our team of recruiters and hiring managers with an enhanced method for decisionmaking.

          If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a prerecorded Voice Interview andor an SMS Text Messaging interview. If participating in a prerecorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 1015 minutes.

          If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 510 minutes. Your recorded interview(s) via text andor prerecorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to the next round of interviews.

          Travel: While this is a remote position, occasional travel to Humanas offices for training or meetings may be required.

          Scheduled Weekly Hours

          40

          Pay Range

          The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

          
          

          $86,300 $118,700 per year

          
          

          This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company andor individual performance.

          Description of Benefits

          Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support wholeperson wellbeing. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), shortterm and longterm disability, life insurance and many other opportunities.

          
          About us
          

          Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

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          Equal Opportunity Employer

          It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.