Director, Provider Services, Humana, Glen Allen, VA
Humana -
Glen Allen, VA,
US
Director, Provider Services
Date Posted: 2024-06-22
Job description
Become a part of our caring community and help us put health first
The Director, Virginia Medicaid Provider Services leads a team that is accountable for growing positive, long-term relationships with network providers to foster positive provider experiences, accurate and timely provider claims submissions, and high-quality care delivery among network providers, resulting in improved financial and quality performance. This senior market leader will oversee a team of direct and indirect reports responsible for provider relations and training, claims education, provider engagement, and practice transformation. They are responsible for setting strategic direction for these accountable business functions, representing the team at meetings with the state and/or key provider groups, and overseeing that all provider services functions meet contractual requirements and state reports are completed timely and accurately. The Director, Provider Services, requires an in-depth understanding of how organization capabilities interrelate across the team, Virginia Medicaid market, and the enterprise. This is a dynamic role requiring strong leadership experience, critical thinking/problem solving skills, and a strategic mindset. This position is dedicated to the Virginia Medicaid plan and must be based in or willing to relocate to Virginia.
Required Qualifications
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
Interview Format
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
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 will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$123,800 - $170,400 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.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
The Director, Virginia Medicaid Provider Services leads a team that is accountable for growing positive, long-term relationships with network providers to foster positive provider experiences, accurate and timely provider claims submissions, and high-quality care delivery among network providers, resulting in improved financial and quality performance. This senior market leader will oversee a team of direct and indirect reports responsible for provider relations and training, claims education, provider engagement, and practice transformation. They are responsible for setting strategic direction for these accountable business functions, representing the team at meetings with the state and/or key provider groups, and overseeing that all provider services functions meet contractual requirements and state reports are completed timely and accurately. The Director, Provider Services, requires an in-depth understanding of how organization capabilities interrelate across the team, Virginia Medicaid market, and the enterprise. This is a dynamic role requiring strong leadership experience, critical thinking/problem solving skills, and a strategic mindset. This position is dedicated to the Virginia Medicaid plan and must be based in or willing to relocate to Virginia.
- Set strategic direction for and oversee key business functions, including provider relations and training, claims analysis and education, provider quality and value-based payment performance, and practice transformation.
- Builds and supports the development and growth of positive, long-term relationships with network providers, including but not limited to primary care providers, hospitals, rural health clinics, human services districts, federally qualified health centers, behavioral health providers, and long-term care providers and healthcare systems in order to maintain service support excellence and improve financial and quality performance within the contracted working relationship with the health plan.
- Regularly review data, such as claims denial/rework data and trends, call center data, and provider performance data to monitor team performance and guide strategic improvements to provider relationships and performance.
- Provides Virginia market oversight and governance of provider audits, compliance, provider surveys, provider service and relations, credentialing, contract management systems, and practice transformation.
- Ensure team's compliance [state]'s Managed Care Contractual requirements for provider relations, such as claims dispute resolution within specified timeframes
- Work closely with enterprise teams on claims processing, reporting, contracting/credentialing, network adequacy, provider dispute resolution issues, and provider performance tracking and tool enhancements.
- Guide the Provider Services Advisor to plan and deliver regular and ad hoc provider communications and provider training and education strategy
- Drives performance, develops operational policies and procedures to align with the provider services model and executes on strategic initiatives within the provider network.
- Represent Humana at meetings with the Virginia Department of Medical Assistance Services
- Participate in, and travel to if needed, key provider meetings and provider association meetings
- Conduct regular performance evaluation of employees and provide ongoing feedback and coaching as necessary to achieve service, quality, and production goals.
- Identify and support professional development for direct and indirect reports to drive exceptional associate engagement and performance
- Set and monitor team key performance indicators
Required Qualifications
- Bachelor's degree
- 5+ years in provider relationship management, provider education, provider issue resolution, and provider value-based performance improvement
- 2+ years of project leadership experience.
- 5+ years of management experience.
- Experience with data analysis, understanding, communicating, and reporting on operational trends and gaps.
- Knowledge of Medicaid regulatory requirements.
- Intermediate knowledge of Microsoft Suite applications, specifically Word, Excel, and PowerPoint.
- Ability to travel throughout Virginia
- Must reside in Virginia
- Masters degree.
- Experience with credentialing and contract management systems
- Working knowledge of managed care health plan and provider operations.
- This position will be Hybrid/Home along with working in the field
- This role is a part of Humana's Driver Safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least100,000/300,000/100,000 limits.
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
- Satellite, cellular and microwave connection can be used only if approved by leadership.
- Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Interview Format
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
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 will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$123,800 - $170,400 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.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.