Humana Inc
This role provides end-to-end oversight of the DSNP Health Home program, ensuring smooth operations and compliance. Key responsibilities include tracking program activity, maintaining accurate policies and procedures, and supporting payer partnerships through meeting coordination and presentation development. The position also leads training efforts for internal teams and external stakeholders.Collaboration is essential, working with partners to resolve plan issues and supporting member communications. The role manages system access for state platforms, oversees compliance projects, and ensures timely updates to provider manuals and websites. Additional duties include maintaining contact lists, handling data files, and providing backup support for program communications.The position will provide support to meet expectations in the 2026 and future SMACs including but not limited to issuing required notices to long-term services and supports when criteria is met and may provide coordination support with complex hospital discharge cases. Overall, this role combines operational management and compliance oversight support to keep the DSNP programs running effectively.Additional duties as assigned.
**Required Qualifications** 3 years of experience in managed care, DSNP programs, health home operations, network management, provider relations, or work with state health agencies/community organizations.
In-depth knowledge of CMS and state regulations for DSNP, Medicare/Medicaid, and related programs.
Strong organizational and communication skills with the ability to manage diverse stakeholders. Skilled in planning, preparation, and delivering presentations with proven ability to handle multiple projects and meet deadlines with attention to detail.
Proficiency in healthcare systems and Microsoft Office Suite.**Preferred Qualifications** Experience with project management tools and methodologies. Advanced knowledge of CMS compliance audits and state regulatory processes. Familiarity with payer relations and contract management. Strong data analysis and reporting skills for program performance metrics. Experience developing training programs and leading stakeholder education sessions. Demonstrated ability to lead cross-functional teams and drive process improvements. * 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. #J-18808-Ljbffr
**Required Qualifications** 3 years of experience in managed care, DSNP programs, health home operations, network management, provider relations, or work with state health agencies/community organizations.
In-depth knowledge of CMS and state regulations for DSNP, Medicare/Medicaid, and related programs.
Strong organizational and communication skills with the ability to manage diverse stakeholders. Skilled in planning, preparation, and delivering presentations with proven ability to handle multiple projects and meet deadlines with attention to detail.
Proficiency in healthcare systems and Microsoft Office Suite.**Preferred Qualifications** Experience with project management tools and methodologies. Advanced knowledge of CMS compliance audits and state regulatory processes. Familiarity with payer relations and contract management. Strong data analysis and reporting skills for program performance metrics. Experience developing training programs and leading stakeholder education sessions. Demonstrated ability to lead cross-functional teams and drive process improvements. * 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. #J-18808-Ljbffr