Manager, Provider Relations

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Lead a team of provider relations associates.

• Foster positive, long-lasting relationships with LTSS providers within Humana's Illinois plans.

• Communicate and implement company policies and information for team members.

• Train and educate the team on various platforms and systems.

• Oversee team assignments to guarantee coverage, quality, and service levels.

• Conduct performance evaluations for employees and provide constructive feedback and coaching.

• Monitor state standards and guidelines, coordinating both internally and externally for alignment.

• Ensure comprehension of Evidence-Based Practices programs, including ACT, MST, FFT, and Homebuilders.

• Address and respond to provider inquiries, concerns, and issues related to claims payment, prior authorizations, and referrals.

• Inform providers about their participation in Humana's Virginia Medicaid plan.

• Collaborate with corporate partners to resolve provider-related issues.

• Utilize claims, reimbursement, and provider enrollment resources and systems to facilitate provider interactions.

• Ensure adherence to Illinois managed care contractual obligations, including claims dispute resolution timelines.

• Travel across Illinois, with 25% travel required.

⛳️ Requirements

• Must reside in Illinois.

• Bachelor's Degree with a minimum of 4 years of progressive experience in managed care operations, including network management and provider relations; alternatively, a High School Diploma with 7 or more years of relevant experience.

• At least 3 years of experience in Medicaid.

• A minimum of 2 years of management and team building experience, including supervising 5–10 employees.

• Experience collaborating with primary care providers, FQHCs, hospitals, nursing facilities, and/or HCBS and LTSS providers.

• Willingness to travel 25% throughout Illinois.

• A Master's Degree is preferred.

• At least 1 year of experience in contract negotiation and implementation is preferred.

• Familiarity with Illinois Medicaid, provider landscape, and networks is preferred.

• A valid state driver's license is required.

• Proof of personal vehicle liability insurance with minimum limits of 100/300/100 is necessary.

• Minimum home internet speeds of 25 Mbps download and 10 Mbps upload are required.

• A dedicated workspace without ongoing interruptions to safeguard PHI/HIPAA information is essential.

• Availability from Monday to Friday, 8:00 am to 5:00 pm CST is required.

🏝️ Benefits

• Bonus incentive plan.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Mileage reimbursement for work-related travel.

• Remote/home workstyle.

• Dedicated home workspace arrangement.

• Home internet service support/requirement for remote work.