Humana Manager - Provider Credentialing in Louisville, Kentucky

Role: Manager – Credentialing Assignment: PPS Location:Louisville, KY

Humana is seeking a Manager who will lead and guide a department of onshore and offshore associates to perform initial credentialing and recredentialing related activities while meeting compliance and accreditation standards. The Credentialing Manager will work closely with Provider Network Operations as well as National Network Operations in order to deliver optimal service to our members and providers. The Credentialing Manager will be responsible for the strategic planning and implementation of newly acquired or expanded business. Vendor relationship management and budgeting oversight are additional responsibilities of the Credentialing Manager to ensure business needs are met in a cost efficient manner.

The efficient and effective integration of business processes is one of many challenges faced by a growing business. The Credentialing Manager drives the operational execution of Humana's business strategy by acting as liaison, alleviating barriers to cooperation and collaboration, and encouraging ongoing feedback to ensure all associates can contribute at optimal levels. This person will deliver service and operational excellence through the consistent application of Human Capital strategies which focus on continuous improvement in the areas of contributions, competencies, and performance.

Implementation / Execution

· Effectively leverages available resources (financial, people, time) to accomplish objectives and maximize return on investment. Makes appropriate decisions in the face of ambiguity. Anticipates and resolves barriers and constraints.

· Organizes and manages multiple priorities and/or projects using appropriate methodologies and tools.

Problem Solving

· Proactively identifies, evaluates, and solves problems with rigorous logic and a systematic approach; looks beyond the obvious to see root cause issues and creative solutions.

Provider Network Operations

· Understanding of provider-focused customer service operations, systems, processes and methods in support of maintaining an active health care provider network.

· Understands operational components of contracting with providers and hospital systems to provide health care services to our members, focusing on contract, plan loading, and maintenance; provider claim management; medical treatment referrals and authorizations; and medical management.

· Is able to leverage service and issue resolution strategies to deliver an exceptional provider experience.

Builds Human Capital

· Identifies, selects, and retains Humana's diverse talent, capitalizing on associates' competencies, ideas and passion.

· Aligns talent with key components of our business strategy to create value for all stakeholders.

· Assesses, develops and rewards talent, encouraging progression throughout the enterprise. Motivates and inspires associates to higher levels of engagement, productivity and personal achievement.

· Provides regular, timely guidance/feedback to encourage developmental opportunities for associates, both direct and indirect reports.


· Ensures understanding regardless of the communication vehicle; understands the needs and perspectives of others and tailors delivery accordingly; shares information appropriately; actively listens.

Customer Value Chain, Competitive Intelligence, Strategic Analysis and the Humana Business Model

· Understanding of the competitive environment, including Humana's marketplace, industry, competition and regulatory environment, as well as understanding of how the components of Humana's business model (i.e. strategy, finances, and operations) interrelate to make Humana competitive in the marketplace.

· Understanding of Humana's business processes, systems, tools, regulations and structure and how they interrelate to provide products and services that create value for Humana customers, consumers and key stakeholders.

· Understanding of how the value we create for our customers, consumers and key stakeholders aligns with Humana's vision, business, culture, value proposition, brand promise and strategic imperatives.

· Understanding of Humana's past and present achievements and shortcomings to assess strengths, weaknesses, opportunities, and risks in relation to the competitive environment.

Role Essentials

  • 2 or more years of management experience
  • Highly engaged and the ability to positively engage and motivate others
  • Strong attention to detail
  • Excellent written and verbal communication skills

Role Desirables

  • Bachelor’s in business or related field
  • Operational management experience overseeing 20 associates
  • Familiarity with state, CMS and health plan accrediting bodies’ credentialing standards (i.e. NCQA, URAC, AAAHC)
  • Strong Microsoft Office skills (ability to analyze data for decision making purposes, create workflows and presentations)

Reporting Relationships This role will report to a PPS Director

Additional Information Travel is approximately 15-20% of the time

Title: Manager - Provider Credentialing

Location: KY-Louisville

Requisition ID: 179006

Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.