Manager, Provider Services Behavioral Health - Humana
Richmond, VA
About the Job
Become a part of our caring community and help us put health first
The Manager, Provider Services - Behavioral Health (BH) leads a team of provider relations associates responsible for growing positive, long-term relationships with network BH providers in Humana's Healthy Horizons Virginia Medicaid plan through day-to-day, front-line relationship management. The Manager is responsible for facilitating a positive provider relationship management experience, through provider training, education, responding to provider inquiries, and resolving issues or complaints. Understands key internal systems that support the provider experience. This individual identifies and leads opportunities to make changes to improve operations across teams and works on general matters in which analysis of issues, data and processes require evaluation of multiple factors.
+ Explain and administer company policies/information required for team members to successfully perform their duties
+ Train and Educate team on platforms and systems used in everyday work
+ Manage teamwork assignments to ensure adequate coverage to meet quality and service levels
+ Conduct regular performance evaluation of employees and provide ongoing feedback and coaching as necessary to achieve service, quality, and production goals
+ Monitor state standards and guidelines and coordinate interdepartmentally and externally to confirm alignment
+ Ensure solid understanding of the specialized BH services that comprise the states Community Based Services such as Mental Health Rehab Agencies, Local Governing Entities (LGE), and CMHCs
+ Ensure a solid understanding of Evidenced based Practices programs (ACT, MST, FFT, Homebuilders)
+ Ensure prompt responsiveness and appropriate triage of provider inquiries, concerns, or problems, including those associated with claims payment, prior authorizations, and referrals, as well as appropriate education about participation in Humana's Virginia Medicaid plan
+ Work with internal corporate partners to ensure cross-department communication and resolution of provider's issues
+ Work with internal resources and systems (e.g., claims, reimbursement, provider enrollment) to provide the Perfect Experience in all provider interactions with Humana's Virginia Medicaid plan
+ Ensure compliance with Virginia's managed care contractual requirements for provider relations, such as claims dispute resolution within specified timeframes
Use your skills to make an impact
Required Qualifications
+ Bachelor's Degree with 4+ years of progressive experience in managed care operations, including network management and provider relations OR 7+ years of progressive experience in managed care operations, including network management and provider relations
+ 2+ years of progressive experience in Behavioral Health managed care operations and provider relations with BH and substance use disorder providers
+ 2+ years of BH management and team building experience including supervising a staff of at least 5-10 employees
+ Proven planning, preparation and presenting skills
+ Demonstrated ability to manage multiple projects and meet deadlines.
+ Exceptional relationship management skills
+ Prior experience working in and strong understanding of Medicaid
+ Ability to manage multiple priorities in a fast-paced environment
+ Knowledge of Microsoft Office applications
+ Must reside in Virginia
+ Ability to travel as needed throughout Virginia
Preferred Qualifications
+ Master's Degree
+ Contract negotiation and implementation experience
Additional Information
+ This position will be remote
+ This role is a part of Humana's Driver Safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.
Work at Home Criteria
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 recommended; wireless, wired cable or DSL connection is suggested.
+ Satellite, cellular and microwave connection can be used only if approved by leadership.
+ Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Interview Format
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
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.$76,800 - $105,800 per yearThis 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
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 - 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, Medicaid, families, individuals, military service personnel, and communities at large.
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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
The Manager, Provider Services - Behavioral Health (BH) leads a team of provider relations associates responsible for growing positive, long-term relationships with network BH providers in Humana's Healthy Horizons Virginia Medicaid plan through day-to-day, front-line relationship management. The Manager is responsible for facilitating a positive provider relationship management experience, through provider training, education, responding to provider inquiries, and resolving issues or complaints. Understands key internal systems that support the provider experience. This individual identifies and leads opportunities to make changes to improve operations across teams and works on general matters in which analysis of issues, data and processes require evaluation of multiple factors.
+ Explain and administer company policies/information required for team members to successfully perform their duties
+ Train and Educate team on platforms and systems used in everyday work
+ Manage teamwork assignments to ensure adequate coverage to meet quality and service levels
+ Conduct regular performance evaluation of employees and provide ongoing feedback and coaching as necessary to achieve service, quality, and production goals
+ Monitor state standards and guidelines and coordinate interdepartmentally and externally to confirm alignment
+ Ensure solid understanding of the specialized BH services that comprise the states Community Based Services such as Mental Health Rehab Agencies, Local Governing Entities (LGE), and CMHCs
+ Ensure a solid understanding of Evidenced based Practices programs (ACT, MST, FFT, Homebuilders)
+ Ensure prompt responsiveness and appropriate triage of provider inquiries, concerns, or problems, including those associated with claims payment, prior authorizations, and referrals, as well as appropriate education about participation in Humana's Virginia Medicaid plan
+ Work with internal corporate partners to ensure cross-department communication and resolution of provider's issues
+ Work with internal resources and systems (e.g., claims, reimbursement, provider enrollment) to provide the Perfect Experience in all provider interactions with Humana's Virginia Medicaid plan
+ Ensure compliance with Virginia's managed care contractual requirements for provider relations, such as claims dispute resolution within specified timeframes
Use your skills to make an impact
Required Qualifications
+ Bachelor's Degree with 4+ years of progressive experience in managed care operations, including network management and provider relations OR 7+ years of progressive experience in managed care operations, including network management and provider relations
+ 2+ years of progressive experience in Behavioral Health managed care operations and provider relations with BH and substance use disorder providers
+ 2+ years of BH management and team building experience including supervising a staff of at least 5-10 employees
+ Proven planning, preparation and presenting skills
+ Demonstrated ability to manage multiple projects and meet deadlines.
+ Exceptional relationship management skills
+ Prior experience working in and strong understanding of Medicaid
+ Ability to manage multiple priorities in a fast-paced environment
+ Knowledge of Microsoft Office applications
+ Must reside in Virginia
+ Ability to travel as needed throughout Virginia
Preferred Qualifications
+ Master's Degree
+ Contract negotiation and implementation experience
Additional Information
+ This position will be remote
+ This role is a part of Humana's Driver Safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.
Work at Home Criteria
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 recommended; wireless, wired cable or DSL connection is suggested.
+ Satellite, cellular and microwave connection can be used only if approved by leadership.
+ Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Interview Format
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
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.$76,800 - $105,800 per yearThis 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
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 - 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, Medicaid, families, individuals, military service personnel, and communities at large.
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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
Source : Humana