Director, Provider Engagement

Humana Inc; United States; On-site; USD 139,000 - 191,000; Full time

Benefits offered by this job

Medical/Dental/Vision

401(k)

Time off benefits

Disability insurance

Life insurance

Other opportunities

Job summary

Humana, Inc. seeks a Director, Indiana Medicaid Provider Services, to lead a strategic team focused on enhancing provider relationships, claims education, and network engagement within Indiana Medicaid.

The role drives performance, ensures contractual compliance, and guides operational programs across provider relations, training, and audits. The leader will oversee complex projects, partner with state bodies, and travel as needed to Indiana facilities, delivering high-quality service and

Qualifications

• Master's Degree or equivalent experience.
• 8+ years provider contracting or relations experience.
• Knowledgeable on Federal/State contractual provider requirements.
• 5+ years of management experience.
• Project management and initiative oversight experience.
• Ability to travel.
• Knowledgeable on provider contracting and credentialing processes.
• Must be passionate about contributing to an organization focused on improving consumer experiences.

Responsibilities

• Lead and develop the Indiana Medicaid Provider Services team.
• Set strategic direction for provider relations, training, claims education, and practice transformation.
• Oversee provider audits, surveys, disputes, reporting, and performance tracking.
• Represent the team at state meetings and with provider associations.
• Ensure compliance with Indiana Managed Care Contractual requirements and service levels.
• Monitor metrics and drive improvements for provider experiences and financial/quality outcomes.

Skills

Provider relations leadership

Management experience

Project management

Travel readiness

Credentialing processes

Customer experience focus

Health solutions industry knowledge

Financial trend analysis

Education

Master's degree

Job description

Director, Indiana Medicaid Provider Services

The Director, Indiana Medicaid Provider Services, leads a team accountable for growing positive, long-term relationships with LTSS providers. We do this in order to foster positive provider experiences, submit accurate and timely provider claims, and deliver high-quality care among network providers. , this leads to 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 set strategic direction for those accountable departments. They represent the team at meetings with the state or main provider groups. They oversee provider services functions to meet contractual requirements and complete state reports timely and accurately. The Director, Provider Services, requires an in-depth understanding of how organization capabilities interrelate across the team, IN Medicaid market, and the enterprise. This is a dynamic role requiring experience. This position is dedicated to the Indiana Medicaid plan and must be based in or willing to relocate to Indiana. Set strategic direction for and oversee main departments, including provider relations and training, claims analysis and education, provider payment performance, and practice transformation Develop operational procedures to align with the provider services model and execute on strategic programs within the provider network Allow the growth of positive, long-term relationships with LTSS/HCBS providers to foster provider retention and improve financial and quality performance within the contracted working relationship with the health plan. Provide Indiana market oversight and governance of provider audits, provider surveys, provider service and relations, and provider feedback. Review reports provider complaints data and trends, claims denials/rework data and trends, provider training and communications, and provider performance data in order to monitor team performance and guide strategic Improvements where needed Represent the provider services team at all state meetings. Meet with main providers, and provider associations Ensure team's compliance with Indiana's Managed Care Contractual requirements for provider relations, such as claims dispute resolution within specified timeframes Set and monitor team measurements and strategic goals Work enterprise teams on provider call center, claims processing, reporting, contracting/credentialing, network adequacy, provider dispute resolution issues, and provider performance tracking and tool enhancements. Plan and build regular and ad hoc provider communications and strategy for provider training Conduct regular performance evaluation of employees and provide ongoing feedback to achieve service, quality, and production goals. Identify and support professional development for their team to grow associate engagement and performance Use your skills to make an impact Requires travel 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. $138,900 - $191,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Required Qualifications

• Master's Degree or equivalent experience
• 8 or more years Provider Contracting or Relations experience
• Knowledgeable on Federal/State contractual provider requirements
• 5 or more years of management experience
• Project management and initiative oversight experience
• Ability to travel
• Knowledgeable on provider contracting and credentialing processes
• Must be passionate about contributing to an organization focused on improving consumer experiences
• Must Reside in Indiana and will attend meetings in the Indianapolis office

Preferred Qualifications

• Prior work experience in the health solutions industry with expertise directing and leading teams
• Proficiency in quality improvement processes, analyzing financial trends

Additional Information

• Requires travel
• 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. $138,900 - $191,000 per year

Description of Benefits

• 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
• many other opportunities

About Us

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 atHumana.comand atCenterWell.com.

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.