The Senior Contract Tools, Education, Processes Professional builds templates, standard documentation, policy and protocol, case studies, and disseminates best in class knowledge.
The Senior Contract Tools, Education, Processes Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
Responsibilities
The Senior, Contract Tools, Education and Processes Professional for Medicaid Network Implementation is responsible for ensuring the full range of network requirements for the Network Expansion and Optimization division of National Network Operations.
The Senior Professional provides internal support to Provider Network by following through all tasks related to provider operations.
Functions include but are not limited to, helping facilitate the business development team and coordinating with the markets and provider service organization to ensure that the network is fully implemented within the RFP and state provider network requirements.
Reviews state Medicaid RFP, model contracts, and related amendments identifying provider network requirements that need to have a policy and procedure created
Creates needed policies and procedures in collaboration with the market contracting and provider relation teams to ensure that the policies and procedures not only meet the requirement, but are operational within the market
Ensures all policies and procedures are delivered to compliance within the required timeframes, including all revisions during implementations
Updates or reviews Medicaid market policies and procedures, as needed
Collaborates with other business areas to ensure project success
Attends all assigned Medicaid meetings
Completes other special projects and duties as requested
Required Qualifications
Bachelor's Degree in Business, Healthcare Administration, Mathematics and/or related field
2+ years of provider network implementation technical experience
Medicaid experience
Healthcare and/or managed care experience
Ability to handle mid-scale projects and/or project management experience
Solid experience of interpretation and independent determination of the appropriate courses of action during projects
Possesses a solid understanding of how organization capabilities interrelate across department(s)
Clear oral and written communication skills
Flexible, dynamic personality who works well in a team environment
Preferred Qualifications
Master's Degree in Business and/or related field
Understanding of legislative and/or legal regulation industry
Experience writing and editing policies and procedures
Work-At-Home Requirements
Must have the ability to provide a high-speed DSL or cable modem for a home office.
Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
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 decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$76,800 - $105,800 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.
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