Manager Provider Relations - Medicaid Behavioral Health

Profile

Description

The Provider Relations Manager - Behavioral Health (BH) oversees, leads, and supports a team of associates that grow positive, long-term relationships with contracted BH providers in order to facilitate a positive provider relationship management experience, including 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.

Responsibilities


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 Louisiana 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 Louisiana Medicaid plan
Ensure compliance with Louisiana's managed care contractual requirements for provider relations, such as claims dispute resolution within specified timeframes


Required Qualifications


Bachelor's Degree, 4 or more years working in the Behavioral Health field
2 years of progressive experience in Behavioral Health managed care operations and provider relations with BH and substance use disorder providers in the state of Louisiana
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.
Position is field based and requires frequent travel to providers and Humana facilities in Louisiana


Preferred Qualifications


Experience with Louisiana Medicaid
Contract negotiation and implementation experience
Proven working knowledge of Behavioral Health provider operations and knowledgeable on the Louisiana scope of BH providers/services, competitor strategies, financial/contracting arrangements, and/or regulatory requirements.


Additional Information

This position is open to working remote in Louisiana during CST hours (Central Standard Time)

Work at Home Policy

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.


#LI-Remote

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Scheduled Weekly Hours

40

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 ****

Company info

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