Humana Manager Provider Education & Relations in Louisville, Kentucky

Role: Manager, Provider Education and Relations

Assignment:Humana Government Business

Location:Work at Home, anywhere in the East

Humana Government Business, Inc. (Humana Government) is a wholly owned subsidiary of Fortune 100 health and wellness company Humana Inc. Headquartered in Louisville, KY, we have been a Department of Defense TRICARE Managed Care Support Contractor since 1995, currently serving more than 3 million beneficiaries in the South Region of the United States. Humana Government Business has the proven experience and capability to manage highly complex, large-scale health care programs throughout the federal government. Humana Government Business is comprised of several lines of business including Humana Military, Clinical Resources, and Patient Appointing Services

Assignment Capsule

Establish and maintain an appropriate and viable network of providers throughout their Prime Service Areas (PSAs) and Non-Prime Service Areas (NPSAs). Manages an outreach and education program on TRICARE requirements to 60,000 network and 90,000 TRICAR-authorized providers. Manages the TRICARE education program that includes education on applicable TRICARE program requirements and policies and procedures to allow providers to carry out the requirements of this contract in an efficient and effective manner, while promoting beneficiary satisfaction. Responsible for ensuring the East Region providers are prepared for transition to the new T2017 TRICARE contract while communicating the expectation for providers to understand and act in compliance when delivering healthcare services. They will be responsible for promoting beneficiary satisfaction through positive provider experiences, while simultaneously advocating an increase in utilization of provider self-service and paperless transactions.
/ / Management of training, process improvement, personnel development, and team leadership of approximately 10 direct reports.

Management of daily operations associated with developing and maintaining a high quality and cost effective provider network through the efforts of the Provider Education Relations Representatives (PERRs). Efficiently and effectively addressing Military Treatment Facilities (MTFs) issues related to the Network and or the providers.

Key Competencies

  • Manage a team of Provider Education and Relations Representatives (PERRs) delivering appropriate education to network and TRICARE authorized providers and their staff within required time frames and in accordance with Humana Government Business contract standards.

  • Develop and monitor goals & objectives for PERRs within a geographic area.

  • Manage the PERR team interactions and responsibilities with the MTFs ensuring contractual compliance with education requirements and needs.

  • Manage compliance with TRICARE policy and CFR regulations as it relates to provider education.

  • Manage and maintain a preferred provider strategy and guidelines to foster optimum steerage of beneficiaries to appropriate network providers and facilities

Role Essentials

  • High School diploma
  • Minimum of three years leadership and management experience in Network Development or Government Contracts
  • Experience in the military healthcare delivery system
  • Strong organization and prioritization skills
  • Ability integrate and coordinate content from various sources to establish deliverables for multiple stakeholders and hold others accuntable for delivering

  • Ability to apply the principles of independent logical thinking to define problems, collect data, establish facts, draw valid conclusions and make strategic recommendations

  • Strong verbal and written communication skills

Role Desirables

  • Bachelor's degree or experience equivalent to education

  • Previous experience with TRICARE contracts or Government Healthcare

Reporting Relationships

You will have 6-15 direct reports, and you will report to a Director, Provider Education and Relations.

Additional Information

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. If you share our passion for helping people, we likely have the right place for you at Humana.

Title: Manager Provider Education & Relations

Location: KY-Louisville

Requisition ID: 177413