Market Network Operations Lead Behavioral Health - KY Medicaid

Profile

Job Information

Humana

Market Network Operations Lead (Behavioral Health) - KY Medicaid

in

Cincinnati

Ohio

Description

The Behavioral Health Network Operations Lead will be our Subject Matter Expert on Kentucky Medicaid Behavioral Health. Responsibilities will include maintaining provider relations to support customer service activities through data integrity management and gathering of provider claims data needed for service operations. Will support the local market from an operational standpoint.

Responsibilities

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 Louisiana 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.

In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:

o Medical Benefits

o Dental Benefits

o Vision Benefits

o Health Savings Accounts

o Flex Spending Accounts

o Life Insurance

o 401(k)

o PTO including 7 paid holidays, two personal holidays, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time

o And more

Required Qualifications

Bachelor's degree

5 or more years of behavioral health provider contracting and provider relations

Experience working directly with providers 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

Significant understanding of Medicaid regulatory compliance

Intermediate knowledge of Microsoft Word and Excel

Must have valid driver's license with reliable transportation and the ability to travel within the Kentucky market

Must reside in the State of Kentucky or within reasonable driving distance

Preferred Qualifications

Master's Degree

Experience working in a leadership or mentoring role

Experience with credentialing and contract management systems

Additional Information

This position will be remote/work at home, however, you must live in the State of Kentucky or within driving distance of Kentucky to be considered for this role.

Work-At-Home Requirements

WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

Satellite and Wireless Internet service is NOT allowed for this role.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.

If progressed to offer, you will be required to:

Provide proof of full vaccination or commit to testing protocols

*OR  *

Provide proof of applicable exemption including any required supporting documentation

​​Medical, religious, state and remote-only work exemptions are available.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com