Network Optimization Professional

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

📋 Description

• Conduct performance analysis of the provider network by reviewing provider contracts.

• Ensure quality assurance during the provider onboarding process.

• Manage the provider escalation tracker effectively.

• Collaborate with various departments to execute tasks efficiently.

• Analyze both internal and external data along with market intelligence.

• Monitor network adequacy data to identify targeted contracting opportunities.

• Assist the Network Optimization Lead with provider terminations.

• Provide support to the Network Optimization Lead with other assigned tasks.

• Help maintain compliance with network requirements for Humana’s Illinois Medicaid plan.

⛳️ Requirements

• A bachelor's degree and a minimum of 2 years of experience in Medicaid managed care operations, provider network contracting, network operations, or network development.

• Candidates lacking a bachelor's degree may be considered with 3 or more years of experience in Medicaid managed care operations, network contracting, network operations, or network development.

• At least 1 year of experience in auditing provider contracts and ensuring quality assurance of provider network loading.

• A minimum of 2 years of experience using Microsoft Office applications, including Word, Excel, and PowerPoint.

• Must reside within the State of Illinois.

• Preference for familiarity with identifying network issues and ensuring compliance with Illinois Department of Healthcare and Family Services requirements.

• Preferred ability to manage large-scale programs with oversight of multiple project teams.

• Knowledge of Humana's internal policies and procedures is preferred.

• Minimum download speed of 25 Mbps and upload speed of 10 Mbps for home internet connection.

• A dedicated workspace free from ongoing interruptions to safeguard member PHI/HIPAA information.

🏝️ 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.

• Self-provided internet service for home work.

• Remote home work arrangement.