Description

Become a part of our caring community and help us put health first
The Manager, Provider Engagement/Relations will lead and support a team of Provider Relationship Managers dedicated to ensuring an exceptional provider experience for Humana Healthy Horizons' Oklahoma Medicaid plan. This leader will oversee relationship management, provider engagement, training, onboarding, issue resolution, and operational compliance, with the goal of driving provider satisfaction, network retention, and adherence to regulatory requirements.

Key Responsibilities:

• Lead, coach, and develop a team responsible for serving as the primary point of contact for physical and behavioral health providers in the Oklahoma Medicaid network.
• Oversee the planning and execution of regular in-person and virtual meetings with providers to deliver training, education, and orientation regarding Humana policies, procedures, and systems.
• Ensure new providers receive effective onboarding support, including orientation sessions and timely access to necessary resources.
• Supervise the teams response to provider questions and inquiries, ensuring prompt and accurate resolution in collaboration with internal enterprise business teams (e.g., claims, prior authorization, referrals, provider education).
• Guide the coordination and facilitation of Service Operating Committee meetings with providers, ensuring effective agendas, materials, and cross-functional participation (clinical, provider engagement, etc.).
• Ensure timely and clear communication of updates regarding Humana's policies, procedures, and Oklahoma's SoonerSelect program to network providers.
• Direct the planning and execution of regional provider townhalls and trainings to promote engagement and satisfaction.
• Collaborate with internal operational teams (e.g., claims, reimbursement, provider enrollment) to support high-quality provider interactions
• Monitor and enforce compliance with Oklahoma managed care contractual requirements, including provider relations processes such as claims dispute resolution within required timeframes.
• Use data, feedback, and performance metrics to identify trends and implement continuous improvement strategies for provider engagement and retention.
• Represent the Provider Relations function in cross-departmental meetings and initiatives as needed.

Use your skills to make an impact

Required Qualifications

• Must reside in Oklahoma
• 4+ years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience
• 2+ years of demonstrated management experience and partnering with senior leadership on strategic initiatives
• Proven planning, preparation and presentation skills, with established knowledge of reimbursement and bonus methodologies
• Demonstrated ability to manage multiple projects and meet deadlines
• Comprehensive knowledge of all Microsoft Office applications
• Ability to travel, as needed

Preferred Qualifications

• Bachelor's Degree
• Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance
• Comprehensive knowledge of Medicare policies, processes and procedures

Additional Information

WAH Internet Statement

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees 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 employees 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.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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.

$86,300 - $118,700 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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.
Requisition #: R-399505

bx2d9wfr1