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Associate Director, Network Operations

2 months ago

St Paul, United States Humana Full time

Become a part of our caring community and help us put health first Humana is seeking an Associate Director, Network Operations to support the Wisconsin Medicaid market. The Associate Director, Network Operations maintains provider network operations to support business activities through credentialing and provider data integrity management needed for service operations. This position requires a solid understanding of how organization capabilities interrelate across department(s). Humana's Wisconsin Medicaid Associate Director, Network Operations manages credentialing and provider data functions for all lines of business including but not limited to demographics, rates, credentialing, network adequacy analysis and reporting, and contract documentation. This role manages the credentialing and provider data management processes and systems. The responsibilities for this role span 5 different lines of business for a total of 6 plans: Medicare DSNP (2 separate plans under this product), Medicaid SSI and Badger Care Plus, Family Care Partnership, and Family Care. Decisions are typically related to identifying and resolving complex technical and operational problems within department(s), and could lead multiple managers or highly specialized professional associates. Duties include but are not limited to: Manage and direct the activities of the leaders over three distinct areas respectively: Provider Data Management and Contract Load, Provider Credentialing, and Certification of 1-2 Bed Adult Family Homes, as well as several Business Support Coordinators who will support these activities. Manage continued compliance with NCQA requirements for the Medicaid lines of business with respect to credentialing and provider data management and reporting. Evaluate and make strategic decisions with respect to positioning the company to attain NCQA designation for the long-term care lines of business. Direct staff for at least the next 2 years working in totally different technology and operational systems. Accountable to direct day to day activities of staff, working with staff in a matrixed environment, making critical complex strategic and operational decisions, making recommendations to executives, and for the delivery of all work in a manner that is consistently compliant with ever changing laws and regulations that govern Medicare and Medicaid programs. Use your skills to make an impact Required Qualifications 7 or more years of progressive provider network or related experience for a government health plan. 3 or more years of solid leadership/management experience or equivalent including supervisory and teambuilding. Experience working with regulatory requirements for government programs to ensure the highest level of data integrity, directory accuracy, adequacy, and regulatory reporting. Strong analytical acumen with proficiency in use of data and reporting and interpreting provider data. Knowledge of credentialing and provider data within Medicare and /or Medicaid lines of business. Preferred Qualifications Bachelor's or master's degree in business administration or finance. Knowledge of NCQA Health Plan and Health Equity Accreditation Standards. Prior work experience with Wisconsin Medicaid and Long-term care. Additional Information Workstyle:

Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs. Location:

must reside within commutable distance to Wisconsin offices for occasional in-person meetings. Travel:

requires occasional travel to Wisconsin for in person meetings. Typical Work days/hours:

Monday - Friday, 8:00 am - 5:00 pm Central Standard Time (CST) Direct Reports:

approximately 9 direct reports

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