Senior Network Operations Manager, Specialty Care
Spring HealthFull Time
Senior (5 to 8 years), Expert & Leadership (9+ years)
Candidates must have at least 2 years of experience in negotiating or servicing managed care contracts with physician, hospital, and/or other provider contracts. They should be proficient in analyzing, understanding, and communicating the financial impact of contract terms, payment structures, and reimbursement rates to providers. Excellent written and verbal communication skills, proficiency in MS Office applications, and the ability to manage multiple priorities in a fast-paced environment are required. Candidates must also live within reasonable driving distance of the Virginia market and have a minimum internet download speed of 25 Mbps and upload speed of 10 Mbps, with wired cable or DSL connection. A Bachelor's degree and experience with behavioral health and Medicaid contracts are preferred.
The Provider Contracting Professional will initiate, negotiate, and execute behavioral health provider contracts for Virginia Medicaid. They will communicate contract terms, payment structures, and reimbursement rates to Behavioral Health providers, and analyze the financial impacts of these contracts. The role involves maintaining contracts and documentation within a tracking system, identifying and recruiting providers based on network composition and needs, and engaging in contracting negotiations with Behavioral Health physicians and Community Mental Health providers. This position involves making decisions on moderately complex issues regarding technical approaches for project components and exercising considerable latitude in determining objectives and approaches to assignments.
Health insurance provider for seniors and military
Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.