Senior Provider Contracting Professional – Behavioral Health

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

📋 Description

• Initiate, negotiate, and finalize contracts and agreements with physicians, hospitals, and other healthcare providers.

• Negotiate competitive pricing for hospital and ancillary contracts.

• Establish and nurture long-lasting relationships with administrators and members of hospitals and group practices.

• Clearly communicate contract details, payment structures, and reimbursement rates to providers.

• Offer a comprehensive network of behavioral health hospitals for consumers.

• Reassess and prioritize both corporate and consumer requirements.

• Evaluate the financial implications of contracts and their terms.

• Maintain contracts and associated documentation within a tracking system.

• Identify and recruit providers based on the composition and needs of the network.

• Engage proactively with other departments to ensure optimal business outcomes.

• Oversee services, care levels, and pricing within the behavioral health network.

• Act as the subject matter expert for the designated region and behavioral health network.

• Manage large accounts and foster provider relationships.

• Collaborate with C-suite stakeholders both internally and externally.

• Implement Humana's consumer-centric business strategy.

⛳️ Requirements

• 3–4 years of progressive experience in network management, specifically in hospital contracting and network administration within a healthcare organization or system.

• Experience in Medicaid behavioral health contracting, including negotiation of contracts.

• Background in Medicaid provider relations.

• Proven experience in negotiating managed care contracts with large physician groups, ancillary providers, and hospital systems.

• Proficient in analyzing, interpreting, and conveying the financial impacts of contract terms, payment structures, and reimbursement rates to providers.

• A Bachelor's Degree is preferred for this role.

• Experience with ACO/Risk Contracting is a plus.

• Familiarity with Value Based Contracting is also desirable.

• Home internet must meet a minimum download speed of 25 Mbps and an upload speed of 10 Mbps.

• Ability to work from a designated space free from interruptions to safeguard 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.

• Support for whole-person well-being.

• Occasional travel to Humana offices for training or meetings.