Become a part of our caring community
 

Join our Illinois Market team in this exciting role as a Network Optimization Professional! Reporting to the Network Optimization Principal, you will play an important role on the Network Optimization team with assisting to ensure compliance with network requirements, including network adequacy, for Humana's Illinois Medicaid plan.

Main Responsibilities

• Analyze provider network performance by auditing Provider contracts and ensuring Quality Assurance on Provider loading.
• Triage the Provider Escalation tracker and collaborate with departments to manage tasks.
• Analyze internal and external data, and market intelligence information.
• Monitor network adequacy data to inform targeted contracting opportunities and assist the Network Optimization Lead with provider terminations.
• Support the Network Optimization Lead on other responsibilities assigned.

Use your skills to make an impact
 

Required Qualifications

• Bachelor's degree with 2+ years of experience in Medicaid managed care operations, provider network contracting, network operations, or network development.
• Candidates without a bachelor's degree may qualify with 3+ years of experience in Medicaid managed care operations, network contracting, network operations, or network development.
• 1 year of experience auditing Provider Contract audits and Quality Assurance of Provider Network loading.
• 2 years of Microsoft Office applications experience- Word, Excel, PowerPoint
• Reside within the State of Illinois

Preferred Qualifications

• Familiarity with identifying network issues, ensure compliance with Illinois Department of Healthcare and Family Services (HFS) requirements, and support network operations.
• Ability to run large-scale, visible programs with responsibility for multiple project teams.
• Knowledge of Humana's internal policies and procedures.

Additional Information

• Workstyle: Remote- Home
• Typical Workdays/Hours: Monday - Friday, 8:00am - 5:00pm Central Standard Time (CST)

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 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.

 

$59,300 - $80,900 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us
 

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.