Manager, Provider Services PCP
Humana
Become a part of our caring community and help us put health first
The Manager, Provider Services – PCP/Medical leads a team of provider relations associates responsible for growing positive, long-term relationships with network PCP/Medical providers in Humana’s Healthy Horizons Virginia Medicaid plan through day-to-day, front-line 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. Understands key internal systems that support the provider experience. This individual identifies and leads opportunities to make changes to improve operations across teams and works on general matters in which analysis of issues, data and processes require evaluation of multiple factors.Explain and administer company policies/information required for team members to successfully perform their dutiesTrain and Educate team on platforms and systems used in everyday workManage teamwork assignments to ensure adequate coverage to meet quality and service levelsConduct regular performance evaluation of employees and provide ongoing feedback and coaching as necessary to achieve service, quality, and production goalsMonitor state standards and guidelines and coordinate interdepartmentally and externally to confirm alignmentEnsure 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 Virginia Medicaid planWork with internal corporate partners to ensure cross-department communication and resolution of provider’s issuesWork with internal resources and systems (e.g., claims, reimbursement, provider enrollment) to provide the Perfect Experience in all provider interactions with Humana’s Virginia Medicaid planEnsure compliance with Virginia’s managed care contractual requirements for provider relations, such as claims dispute resolution within specified timeframes
Use your skills to make an impact
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.
The Manager, Provider Services – PCP/Medical leads a team of provider relations associates responsible for growing positive, long-term relationships with network PCP/Medical providers in Humana’s Healthy Horizons Virginia Medicaid plan through day-to-day, front-line 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. Understands key internal systems that support the provider experience. This individual identifies and leads opportunities to make changes to improve operations across teams and works on general matters in which analysis of issues, data and processes require evaluation of multiple factors.Explain and administer company policies/information required for team members to successfully perform their dutiesTrain and Educate team on platforms and systems used in everyday workManage teamwork assignments to ensure adequate coverage to meet quality and service levelsConduct regular performance evaluation of employees and provide ongoing feedback and coaching as necessary to achieve service, quality, and production goalsMonitor state standards and guidelines and coordinate interdepartmentally and externally to confirm alignmentEnsure 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 Virginia Medicaid planWork with internal corporate partners to ensure cross-department communication and resolution of provider’s issuesWork with internal resources and systems (e.g., claims, reimbursement, provider enrollment) to provide the Perfect Experience in all provider interactions with Humana’s Virginia Medicaid planEnsure compliance with Virginia’s managed care contractual requirements for provider relations, such as claims dispute resolution within specified timeframes
Use your skills to make an impact
Required Qualifications
Bachelor’s Degree with 4+ years of progressive experience in managed care operations, including network management and provider relations OR 7+ years of progressive experience in managed care operations, including network management and provider relationsExperience working for or with key provider types (such as primary care, FQHCs, hospitals, nursing facilities, and/or HCBS and LTSS providers)2+ years of management and team building experience including supervising a staff of at least 5-10 employeesProven planning, preparation and presenting skillsDemonstrated ability to manage multiple projects and meet deadlines.Exceptional relationship management skillsPrior experience working in and strong understanding of MedicaidAbility to manage multiple priorities in a fast-paced environmentKnowledge of Microsoft Office applicationsAbility to travel as needed throughout VirginiaPreferred Qualifications
Master’s DegreeContract negotiation and implementation experienceAdditional Information
This position will be remoteThis 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:
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.Scheduled Weekly Hours
40Pay 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.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. 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), short-term and long-term 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.
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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.
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