Principal – Provider Network Transition Strategy

This is a fully remote position, open to applicants in United States.

📋 Description

• Lead the enterprise strategy for managing transitions and disruptions within Humana's provider network.

• Evaluate the impacts on members, providers, operations, regulations, and business due to changes in the provider network.

• Act as the primary enterprise lead for initiatives related to provider terminations and network transitions.

• Collaborate with teams in Provider Contracting, Market Leadership, Member Retention, Stars, Provider and Member Service, Compliance, Provider Network Operations, and other key stakeholders.

• Formulate and execute strategies to mitigate risks.

• Identify emerging risks and opportunities within the provider network and propose actions to senior leadership.

• Enhance experiences for both providers and members while minimizing operational friction and execution risks.

• Facilitate governance and decision-making processes at the executive level concerning provider network transitions and enterprise risk mitigation.

• Create reports, analytics, executive communications, and performance tracking for critical provider network occurrences.

• Assess the effects on member retention, access to care, network adequacy, Stars performance, service operations, and overall business outcomes.

• Lead initiatives aimed at simplifying processes and coordinating efforts across various functions.

• Influence organizational leaders within a matrixed environment to foster accountability and eliminate barriers, despite lacking direct operational control.

• Counsel senior leaders and executives regarding strategic initiatives, organizational risks, and potential opportunities.

• Identify and rank opportunities to enhance Humana's capabilities in provider network transitions.

⛳️ Requirements

• Over 7 years of experience in provider contracting, provider network management, healthcare operations, healthcare consulting, or similar roles in healthcare strategy.

• At least 3 years of experience in project, program, or people leadership roles.

• In-depth knowledge of provider network operations, contracting strategies, healthcare delivery systems, and payer-provider relationships, particularly in Medicare Advantage and/or Medicaid contexts.

• Proven experience in leading large, cross-functional initiatives across various business domains.

• Ability to influence leaders and achieve results in a matrixed organization without direct authority over execution teams.

• Proficient in utilizing data and analytics to inform business decisions and executive recommendations.

• Demonstrated effectiveness in communicating with senior leaders and executive stakeholders.

• Willingness to travel up to 10% of the time.

• Must reside in the Central or Eastern Time Zone.

• Preferred: Bachelor's degree.

• Experience navigating complex regulatory, operational, and member experience challenges within a health plan environment.

• Minimum home internet speed of 25 Mbps download and 10 Mbps upload is required.

• Ability to work from a dedicated space free from interruptions to protect member PHI/HIPAA information.

🏝️ Benefits

• Bonus incentive plan based on individual and/or company performance.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Remote/work-at-home arrangement.

• Support for internet service requirements and dedicated workspace for home working.

• Training and meeting travel support as applicable.