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 The Senior Professional Provider Network Strategy will be accountable for supporting the development of Humana Healthy Horizon’s Medicaid network strategy and market approaches in the Medicaid growth pipeline states. This network strategist will provide research driven advisement to support the development of adequate and accessible networks and market specific provider network approaches to advance market entry.

The Senior Professional will also facilitate the development and or enhancement of team and department strategies and operational procedures. The position requires experience with synthesizing and evaluating multiple sources of qualitative and quantitative information to inform network market entry priorities and positioning. Additionally, this position requires an in-depth understanding of how organizational capabilities interrelate within the enterprise to develop and execute on network strategy.

The Senior Professional Provider Network Strategy roles and responsibilities include:

Conducts discovery research and analysis of regulatory network and provider requirements to inform the Humana Medicaid Growth Market Network Strategic Plan, under the guidance of the Strategy Advancement Advisor.Project manages the development of provider and network market entry strategy and approaches among the Medicaid Value Based and Provider Solutions department leadership.Supports the development of provider and network Request for Proposal (RFP) responses to advance Humana’s Medicaid growth strategy in new and rebid markets.Facilitates the development, documentation, and periodic updates of team operational process and procedure documents.Evaluates teams processes and supports to business areas and developments and implements actions plans to solution for identified opportunities.Assesses health plan provider network operations of market entry regulatory requirements and plan commitments to inform market RFP rebid approach.Exercises independent judgment and decision making on complex issues regarding job duties and related tasks requiring analysis of variable factors and determining the best course of action and works under minimal supervision.
Use your skills to make an impact
 

Required Qualifications

Bachelor's degree.3 + years of experience researching and interpreting CMS, state Medicaid, and other quantitative and quality regulatory sources.2+ years of project leadership experience.2+ years of Medicaid experience.Strong comprehension of federal and or state Medicaid provider network regulations and requirements and health plan network operations.

Preferred Qualifications

Master’s degree in business administration, healthcare administration, public administration, public health, or public policy.

Work From Home

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.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.

Additional Information:

Workstyle: Remote – work at home.Location/Travel: Contiguous United States, up to 10% travel is expected for this role.Core Workdays & Hours: Typically, Monday – Friday 8:00am – 5:00pm Eastern Standard Time (EST).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 an exciting interviewing technology provided by Hire Vue, a third-party vendor.  This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.  If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 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 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

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 and/or individual performance.

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.

Application Deadline: 04-29-2025
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.