Senior Network Optimization Professional

CarePlus Health Plans Inc

Michigan, US
$78,400 - $107,800 py; bonus incentive plan availa...
Remote with occasional travel (up to 10%) to humana's detroit office.
Analyze network performance data
Support provider contracting decisions
Resolve operational issues
Humana is seeking a Senior Network Optimization Professional to manage and enhance their Michigan Medicare/Medicaid provider network, ensuring compliance and optimizing network value. The role requires extensive experience in provider network operations, data analysis, and collaborative problem-solving within a remote work environment

Job Summary

  • The Senior Network Optimization Professional drives network optimization and value and managing compliance with network requirements - including network adequacy - for Humana’s Michigan Medicare/Medicaid Integrated plan.
  • Responsibilities include analyzing network performance, supporting provider contracting decisions, collaborating to resolve operational issues, and advising on network strategy.
  • Humana offers competitive benefits that support whole-person well-being, including medical, dental and vision benefits, 401(k) retirement savings plan, and time off.

Matching Summary

Match Score: 85

Humana is seeking a Senior Network Optimization Professional to manage and enhance their Michigan Medicare/Medicaid provider network, ensuring compliance and optimizing network value. The role requires extensive experience in provider network operations, data analysis, and collaborative problem-solving within a remote work environment.

Salary

$78,400 - $107,800 per year; Bonus incentive plan available; Comprehensive benefits package

Skills & Requirements

Must-have

  • Analyze network performance data
  • Support provider contracting decisions
  • Resolve operational issues
  • Advise on network strategy
  • Monitor network adequacy
  • Manage compliance with network requirements

Nice-to-have

  • Collaborate with internal partners
  • Drive network optimization and value
  • Ensure alignment to financial, operational and clinical goals

Key Requirements

  • Must reside in Michigan or be willing to relocate to Michigan
  • Bachelor’s degree or five (5) years of managed care experience
  • Three (3) or more years of provider network contracting or provider data management experience
  • Two (2) or more years of process creation or improvement experience
  • Proficient in MS Office Applications
  • Ability to manage and prioritize multiple projects
  • Ability to travel in Michigan
  • Valid state driver's license and personal vehicle liability insurance

Work Rights

Not specified

Tailored Resume

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