Sr. Professional Network Strategy

Lensa; Madison (WI); Remote; USD 65,000 - 95,000; Full time

Job summary

An established industry player is seeking a Senior Professional Provider Network Strategist to enhance Medicaid network strategies. This role involves conducting thorough research and analysis to inform strategic plans, managing the development of market entry strategies, and supporting RFP responses. The ideal candidate will possess strong project leadership skills and a deep understanding of Medicaid regulations. Join a dynamic team that values innovation and collaboration, and contribute to making healthcare accessible for millions. If you are passionate about making a difference and have the necessary expertise, this opportunity is perfect for you.

Benefits

Comprehensive benefits package

Competitive pay

Flexible work hours

Qualifications

• 3+ years of experience in Medicaid and regulatory research.
• 2+ years of project leadership in healthcare settings.

Responsibilities

• Conduct research to inform Medicaid network strategies.
• Manage provider and network market entry strategies.

Skills

Research and analysis

Project leadership

Medicaid regulations knowledge

Decision-making

Education

Bachelor's degree

Master’s degree in relevant field

Job description

Senior Professional Provider Network Strategy

About Us: Humana 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.

Job Overview: The Senior Professional Provider Network Strategy will be accountable for supporting the development of Humana Healthy Horizon’s Medicaid network strategy and market approaches in the Medicaid growth pipeline states. This network strategist will provide research-driven advisement to support the development of adequate and accessible networks and market-specific provider network approaches to advance market entry.

Key Responsibilities:

1. Conducts discovery research and analysis of regulatory network and provider requirements to inform the Humana Medicaid Growth Market Network Strategic Plan, under the guidance of the Strategy Advancement Advisor.
2. Project manages the development of provider and network market entry strategy and approaches among the Medicaid Value Based and Provider Solutions department leadership.
3. Supports the development of provider and network Request for Proposal (RFP) responses to advance Humana’s Medicaid growth strategy in new and rebid markets.
4. Facilitates the development, documentation, and periodic updates of team operational process and procedure documents.
5. Evaluates teams processes and supports to business areas and develops and implements action plans to solution for identified opportunities.
6. Assesses health plan provider network operations of market entry regulatory requirements and plan commitments to inform market RFP rebid approach.
7. Exercises independent judgment and decision-making on complex issues regarding job duties and related tasks requiring analysis of variable factors and determining the best course of action and works under minimal supervision.

Required Qualifications:

• 3+ years of experience researching and interpreting CMS, state Medicaid, and other quantitative and quality regulatory sources.
• 2+ years of project leadership experience.
• 2+ years of Medicaid experience.
• Strong comprehension of federal and/or state Medicaid provider network regulations and requirements and health plan network operations.

Preferred Qualifications:

• Master’s degree in business administration, healthcare administration, public administration, public health, or public policy.

Work From Home: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended.

Additional Information:

• Workstyle: Remote – work at home.
• Location/Travel: Contiguous United States, up to 10% travel is expected for this role.
• Core Workdays & Hours: Typically, Monday – Friday 8:00am – 5:00pm Eastern Standard Time (EST).
• Benefits: Benefits are effective on day 1. Full-time Associates enjoy competitive pay and a comprehensive benefits package.

Application Deadline: 04-29-2025

Equal Opportunity Employer: It is the policy of Humana not to discriminate against any employee or applicant for employment based on various protected characteristics.