Market Network Operations Lead (Behavioral Health/Medicaid)

Become a part of our caring community and help us put health firstThe Behavioral Health Network Operations Lead will be the Subject Matter Expert on Ohio Medicaid Behavioral Health. Responsibilities will include maintaining provider relations to support customer service activities through data integrity management. Communicates contract terms, payment structures, and reimbursement rates to providers. Analyzes financial impact of contracts and terms. Maintains contracts and documentation within a tracking system. Identifies and recruits providers based on network composition and needs. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks and works under minimal supervision. Uses independent judgment requiring analysis of variable factors and determining the best course of action.The Behavioral Health Network Operations Lead manages behavioral health provider data for health plans including but not limited to adequacy, accessibility, demographics, rates, and contract intent. Manages provider audits, provider service and relations, credentialing, and contract management systems. Executes processes for intake and manage provider perceived service failures, including response to state inquiries and provider/member complaints. Drives to root cause and subsequent resolution with significant engagement with internal departments. Works closely with the Ohio Medicaid market operational leadership team to ensure regulatory adherence, process improvement, and reduction in provider friction points. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks and works under minimal supervision. Uses independent judgment requiring analysis of variable factors and determining the best course of action.Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including:

Health benefits effective day 1

Paid time off, holidays, volunteer time and jury duty pay

Recognition pay

401(k) retirement savings plan with employer match

Tuition assistance

Scholarships for eligible dependents

Parental and caregiver leave

Employee charity matching program

Network Resource Groups (NRGs)

Career development opportunities

Use your skills to make an impactRequired Qualifications

3+ years of experience with behavioral health provider contracting

Experience working directly with entities such as Community Mental Health Centers, Psychiatric Acute/Residential Facilities, and Medication Assisted Treatment

Experience with analyzing, understanding, and communicating financial trends

Strong process orientation and experience implementing process improvement initiatives

Intermediate knowledge of Microsoft Word and Excel

Must reside within reasonable driving distance to the state of Ohio

Preferred Qualifications

Bachelor's Degree

Understanding of Medicaid regulatory compliance

Experience working in a people leadership role

Experience with credentialing and contract management systems

Additional InformationThis position will be remote, but candidates must live within reasonable driving distance to the state of Ohio as you may be required to travel occasionally within the region.Work-At-Home RequirementsTo 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 ​

#LI-Remote#LI-JR1Scheduled Weekly Hours40Pay 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.$93,000 - $128,000 per yearThis 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.About usHumana 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 EmployerIt 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  Humana to 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.Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=HumanaWebsite.