Become a part of our caring community and help us put health first
 

The Director, Network Adequacy tests the overall network in each county of operations to ensure the network is strong enough to support serving customers. The Director, Network Adequacy requires an in-depth understanding of how organization capabilities interrelate across the function or segment. This position is also responsible for the management of Operational IT Projects related to enhancing the provider and member experience.

• Present and provide strategic guidance regularly to Senior Executive leadership on matters of significance pertaining to Network Adequacy

• Comprehensive Access to Care Monitoring and Oversight

• Network Analysis and Oversight

  • Oversight of network strategy discussions related to best adjustments in provider network

  • Hold others department/areas accountable to strategy decisions made

  • Review access to care gaps, design and implement strategy

  • Review provider quality/financial performance and optimize network

• Network Deficiency Opportunity Review

  • Responsible for ensuring network teams understand and capitalize on opportunities and align on deficiency strategies to mitigate liquate damages

  • Manage all AHCA requests related to Network Deficiencies (Findings, Waives, Quarterly LD reviews)

  • Responsible for implementation of directory data integrity initiatives that improve network adequacy and mitigate liquidate damages

  • Track and communicate, as necessary, PNV errors as related to network deficiencies and overall Humana compliance

• Non Par Spend Monitoring and Oversight

  • Communicate current issues to clinical, network, and all other impacted departments to develop strategic approach to correct

  • Track and communicate improvements seen via KPIs/metrics/discussions

• Waiver Process Enhancement Improvement

  • Develop and implement a process to mitigate liquated damages where possible

  • Once process in place, develop reporting and analysis to track process success/manage overtime

  • Project management of Operational IT Projects related to enhancing provider and member experience

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s Degree in a technical, scientific or related field or equivalent of 5+ years of network adequacy experience in healthcare
• 5+ years of business and healthcare operational experience
• 5+ years of management experience
• Demonstrated strength in troubleshooting complex infrastructure incidents and problems
• Experience implementing, integrating, and managing public and private cloud platforms
• Microsoft Office knowledge
• Must be available to travel 10%

Preferred Qualifications

• Experience with Medicaid and or Florida Medicaid
• Advanced certifications or comparable work experience in software
• Master’s Degree or comparable work experience

Work-At-Home Requirements

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates 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
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates 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, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor.  This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive an email correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. (please be sure to check your spam or junk folders often to ensure communication isn’t missed) If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

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.

 

$112,400 - $154,900 per year

 

This 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 because he or she is a protected veteran. 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.