Manager Network Operations - WA/UT

Profile

Job Information
Humana
Manager, Network Operations - WA/UT
in
Sandy
Utah
Description
The Manager, Network Operations maintains provider relations to support customer service activities through data integrity management and gathering of provider claims data needed for service operations. The Manager, Network Operations works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.
Responsibilities
The Manager, Network Operations manages provider data for health plans including but not limited to demographics, rates, and contract intent. Manages provider audits, provider service and relations, credentialing, and contract management systems. Executes processes for intake and manage provider perceived service failures. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.
Required Qualifications
Bachelor's Degree
6 or more years of experience with Providers and Analytics
2 or more years of management experience
Strong Excel Skills
Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena
Proven contract preparation skills, with an in-depth knowledge of Medicare and other reimbursement methodologies
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
Master's Degree in Business Administration or Finance
Experience with ACO/Risk Contracting
Additional Information
For this job, associates are required to be fully COVID vaccinated, including booster or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
If progressed to offer, you will be required to:
Provide proof of full vaccination, including booster or commit to testing protocols
*OR  *
Provide proof of applicable exemption including any required supporting documentation
​​Medical, religious, state and remote-only work exemptions are available.
Scheduled Weekly Hours
40

Company info

Sign Up Now - FinancialServicesCrossing.com