Manager of Provider Engagement - Humana Gold Plus Integrated

Employment Type: Full-time

Position Overview

Humana Gold Plus Integrated is seeking a Manager of Provider Engagement to lead a team of provider relations professionals. This role is crucial for growing positive, long-term relationships with network PCP/Medical providers in Humana’s Dual Fully Integrated plan of Illinois. The Manager will be responsible for facilitating a positive provider relationship management experience through training, education, responding to inquiries, and resolving issues by understanding key internal systems that support the provider experience.

Responsibilities

• Explain and administer company policies/information required for team members to successfully perform their duties.
• Train and educate the team on platforms and systems used in everyday work.
• Manage teamwork assignments to ensure adequate coverage to meet quality and service levels.
• Conduct regular performance evaluations of associates and provide ongoing feedback and coaching to achieve service, quality, and production goals.
• Monitor state standards and guidelines and coordinate interdepartmentally and externally to confirm alignment.
• Ensure 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 Illinois Medicaid plan.
• Work with internal corporate partners to ensure cross-department communication and resolution of provider’s issues.
• Work with internal resources and systems (e.g., claims, reimbursement, provider enrollment) to provide the Perfect Experience in all provider interactions with Humana’s Dual Fully Integrated plan of Illinois.
• Ensure compliance with Illinois’s managed care contractual requirements for provider relations, such as claims dispute resolution within specified timeframes.

Required Qualifications

• Must live in or be willing to relocate to the State of Illinois and be able to travel throughout Illinois as needed for the role.
• Education/Experience:
  • Bachelor’s Degree with 4+ years of progressive experience in managed care operations, including network management and provider relations.
  • OR Equivalent work experience with 7+ years of progressive experience in managed care operations, including network management and provider relations.
• Experience 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 employees.
• Prior experience working in and strong understanding of Illinois Medicaid, provider landscape, and networks.
• Proven planning, preparation, and presenting skills, with established knowledge of reimbursement and bonus methodologies.
• Demonstrated ability to manage multiple priorities/projects in a fast-paced environment to meet deadlines.
• Experience working in a matrixed organization and influencing change and direction.
• Intermediate to advanced knowledge of Microsoft Suite applications (Word, Excel, Outlook, and PowerPoint).
• Exceptional relationship management and collaboration skills.
• This role is part of Humana’s Driver Safety program and requires a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.

Preferred Qualifications

• Master’s degree.
• Contract negotiation and implementation experience.
• Comprehensive knowledge of Medicare policies, processes, and procedures.

Work at Home Requirements

• Minimum download speed of 25 Mbps and upload speed of 10 Mbps is recommended.