The Vendor Management Oversight team is committed to effective and efficient Utilization Management solutions for Humana’s Medicare and Medicaid operational business. We are in search for a Vendor Management Professional to work as liaison between UM vendors and the organization. The Vendor Management Professional performs varied activities and moderately complex administrative/operational/member and/or provider escalations. The Vendor Management Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Responsibilities
The Vendor Management Professional reviews terms of vendor contracts and communicates with vendors regarding day-to-day matters. Builds and maintains positive relationship with vendors and monitor vendor performance holding the vendor accountable for meeting performance goals to ensure the vendor is meeting contractual requirements and expected timelines for Medicare and Medicaid LOB. Research contractual issues and resolves discrepancies to improve processes for providers, members, and internal stakeholders. Develops, implements, and follows established guidelines/procedures for UM vended programs. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
Required Qualifications
2 or more years’ experience in clinical operational experience
Utilization Management and CGX access and regular use
Proficient in Microsoft Office applications including Word, Excel and PowerPoint
Strong verbal and written communication skills
Strong facilitation skills
Comfortable working in ambiguity
Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Preferred Qualifications
Some college, or Bachelor's
Certification with Six Sigma and/or the Project Management Institute
Prior experience in Health Plan clinical operations or healthcare setting
Knowledge of Medicare Advantage
Knowledge of Claims Processing and Grievance and Appeals.
Additional Information
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
Social Security Task
Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana’s secure website.
Interview Format
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a first-round interview, you will receive an email correspondence inviting you to participate in a Modern Hire interview. In this interview, you will receive a set of interview questions over your phone, and you will provide recorded or text message responses to each question. You should anticipate this interview to take about 15 minutes. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.
Why Humana?
At Humana, we know your well-being is important to you, and it’s important to us too. That’s why we’re committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. Just to name a few:
Work-Life Balance
Generous PTO package
Health benefits effective day 1
Annual Incentive Plan
401K – Immediate company match
Well-being program
Paid Volunteer Time Off
Student Loan Refinancing
If you share our passion for helping people, we likely have the right place for you at Humana!
Scheduled Weekly Hours
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