The Provider Services Advisor (Market Development Advisor) will be responsible for the strategic and tactical support of the Provider Services team. They will advise the Provider Services Director on the day-to-day and strategic operations of the team, process development and improvement to drive standardization and efficiencies across the team. They will complete related state reports, develop and execute upon a provider communication, and provider materials development strategy. Initially, the Provider Services Advisor (Market Development Advisor) will play a key role in supporting new market implementation activities. They will partner cross-functionally within the market and across the enterprise on matters of significance. This Provider Services Advisor exercises independent judgment and decision making on complex issues regarding job duties and related tasks and works under minimal supervision. They use independent judgment requiring analysis of variable factors and determining the best course of action.
Position Responsibilities:
- Advises Provider Services Director on strategic and day-to-day operations of the overall Provider Services team, which includes provider relations, claims education, provider engagement, and provider performance improvement.
- Establishes infrastructure to measure KPIs and other metrics to ensure compliance with related managed care contractual requirements.
- Develops initial and manage annual updates of the market's Provider Support Plan, in partnership with the Director, as well as any other related required state reporting.
- Oversees provider communications (fax blasts, emails, bulletins, website, or provider portal content updates) end-to-end process, including development of content and management through the approval process.
- Manages provider training and education strategy, including advising on and/or creating market-based provider materials and contributing to provider manual and required training materials.
- Prior to market go-live, contributes to implementation of contractual requirements and day-to-day business processes/functions.
- Leads process development or improvement and communicates them to team members to drive efficiencies, standardization, and best practices for Illinois.
- Drives development of ad-hoc strategic initiatives to execute on the Medicaid Long-Term Services and Support (LTSS)/Home and Community Based Services (HCBS) provider journey, provider relationship management model, and other strategic initiatives.
- Facilitates workgroup calls/meetings/discussions to ensure successful execution of Provider Support Plan.
- Partners with corporate Medicaid Provider Services team to rollout new segment-wide process or technology enhancements in support of the overall Provider Services team.
Required Qualifications:
- Must reside in the state of Illinois.
- Bachelor's Degree.
- 6+ years of related experience, including provider relations or engagement, provider communications and education, and/or related health plan operations
- 2+ years of project management experience
- Strategic thinker with the ability to identify, prioritize, and solve complex business problems
- Experience working in Illinois Medicaid.
- Excellent interpersonal, organizational, written, and oral communication and presentation skills with proven experience writing and delivering presentations to members of the management team and internal business partners
Preferred Qualifications:
- Master's Degree.
- Understanding of managed care contracts, including contract language and reimbursement
- Familiarly with LTSS/HCBS providers and/or DSNP/Medicaid-Medicare integration.
- Strong understanding of health plan operations.
- Experience operating in a matrixed environment
- Project management certification.
Work at Home Requirements: 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 required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours40
Pay RangeThe 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.
$94,900 - $130,500 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of BenefitsHumana, 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
