Provider Contracting Executive

This is a fully remote position, open to applicants in Florida, +2 more states.

📋 Description

• Oversee provider contracting initiatives for designated markets, providers, and provider categories within Georgia.

• Negotiate and finalize provider agreements, amendments, renewals, and terminations in accordance with the enterprise network strategy.

• Foster and sustain relationships with hospitals, physician organizations, ancillary providers, and health systems.

• Address intricate provider issues related to contract interpretation, escalations, and management of relationships.

• Evaluate market conditions, provider performance, reimbursement frameworks, utilization patterns, and competitive landscape.

• Collaborate with internal stakeholders on objectives such as affordability, quality, network sufficiency, growth, and member access.

• Assess the financial and operational implications of proposed contract terms and reimbursement models.

• Support initiatives related to value-based arrangements and alternative payment models.

• Guarantee that contract terms adhere to Humana policies, state and federal regulations, and internal governance standards.

• Work alongside legal, finance, network operations, credentialing, provider engagement, and clinical leadership teams.

• Report directly to the Director of Provider Contracting.

⛳️ Requirements

• Bachelor's degree.

• 6+ years of progressive experience in network management, including hospital contracting and network administration within a healthcare organization.

• 2+ years of experience supporting providers in value-based arrangements.

• Understanding of provider reimbursement methodologies, including fee-for-service and value-based models.

• Strong financial, analytical, and negotiation capabilities.

• Experience delivering presentations to senior leadership.

• Proficient in Microsoft Office applications, particularly Excel and PowerPoint.

• Willingness to travel within Georgia as required for provider meetings, departmental meetings, and market support.

🏝️ 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.

• Work-from-home arrangement.

• Occasional travel to Humana offices for training or meetings.