Director, Network Optimization

Humana

Director overseeing strategic development and maintenance of Ohio Medicaid plan's provider network. Driving network optimization and compliance while collaborating across key leadership teams.

Posted 5/28/2026full-timeRemote • Ohio • 🇺🇸 United StatesLead💰 $138,900 - $191,000 per yearWebsite

About the role

Key responsibilities & impact

Oversees the strategic development and maintenance of Ohio Medicaid plan's provider network
Drives network optimization and value while ensuring compliance with network requirements
Assesses provider network performance to inform contracting and terminations
Works closely with the Provider Relations team to address network operational issues
Sets value-based payment strategy
Creates strategy for Ohio Medicaid provider network, including contracting approaches and unique partnerships
Monitors performance against key performance indicators and contractual commitments
Collaborates with leadership and clinical teams to achieve strategic goals and priorities

Requirements

What you’ll need

Bachelor's Degree
6+ years of experience working with a managed care organization or as a consultant in a network/contract management role, such as contracting, provider services, etc.
2+ years of experience in provider network development, including contracting, network operations, and/or network maintenance
4+ years of experience in value-based contracting models
2+ years of experience in data analysis
Proficiency with a wide range of physician/facility/ancillary contract reimbursement methodologies
Prior leadership and management experience
Ability to manage multiple priorities in a fast-paced environment
Experience working in a matrixed organization and influencing change and direction
Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

Benefits

Comp & perks

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
Many other opportunities

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

provider network developmentcontract managementvalue-based contracting modelsdata analysiscontract reimbursement methodologies

Soft Skills

leadershipmanagementability to manage multiple prioritiesinfluencing changecollaboration

Certifications

Bachelor's Degree