Senior Network Operations Manager, Specialty Care
Spring HealthFull Time
Senior (5 to 8 years), Expert & Leadership (9+ years)
Candidates must have 3-5 years of progressive network management experience, including hospital contracting and network administration in a healthcare company. They should be experienced in negotiating managed care contracts with large physician groups, ancillary providers, and hospital systems, and proficient in analyzing and communicating the financial impact of contract terms, payment structures, and reimbursement rates to providers. Experience with Behavioral Health contracts, excellent written and verbal communication skills, the ability to manage multiple priorities in a fast-paced environment, and proficiency in MS Office applications are also required. Candidates must live within reasonable driving distance of Virginia. A Bachelor's degree and experience with Medicaid contracts are preferred.
The Senior Provider Contracting Professional will initiate, negotiate, and execute physician, hospital, and/or other Behavioral Health contracts and agreements within the Virginia Medicaid space. They will communicate contract terms, payment structures, and reimbursement rates to providers to build and maintain Medicaid Behavioral Health provider networks, and analyze the financial impact of contracts. This role involves maintaining contracts and documentation within a tracking system, assisting with provider identification and recruitment based on network needs, and influencing department strategy. The professional will make decisions on moderately complex to complex issues regarding technical project components with minimal direction.
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.