Network Optimization Professional
$59,300–$80,900 year
RemoteIllinois, United States
Job Summary
Audit provider contracts and ensure quality assurance on provider loading for Humana's Illinois Medicaid plan. Analyze internal data, market intelligence, and provider network performance to inform targeted contracting opportunities. Triage the Provider Escalation tracker and collaborate with departments to manage tasks, including assisting with provider terminations. Monitor network adequacy data to support compliance with network requirements and the Illinois Department of Healthcare and Family Services. This remote role reports to the Network Optimization Principal and involves occasional travel for training or meetings.
Required Qualifications
- Bachelor's degree
- 2+ years of experience in Medicaid managed care operations
- 2+ years of experience in provider network contracting
- 2+ years of experience in network operations
- 2+ years of experience in network development
- 3+ years of experience in Medicaid managed care operations (for candidates without a bachelor's degree)
- 3+ years of experience in provider network contracting (for candidates without a bachelor's degree)
- 3+ years of experience in network operations (for candidates without a bachelor's degree)
- 3+ years of experience in network development (for candidates without a bachelor's degree)
- 1 year of experience auditing Provider Contract audits
- 1 year of experience Quality Assurance of Provider Network loading
- 2 years of Microsoft Office applications experience
- Reside within the State of Illinois
- Download speed of 25 Mbps
- Upload speed of 10 Mbps
- Dedicated space lacking ongoing interruptions
- Ability to work effectively remotely
- Occasional travel to Humana's offices for training or meetings
Desired Qualifications
- Familiarity with identifying network issues
- Ensure compliance with Illinois Department of Healthcare and Family Services (HFS) requirements
- Support network operations
- Ability to run large-scale, visible programs
- Responsibility for multiple project teams
- Knowledge of Humana's internal policies and procedures
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