[Remote] Director, Network Contracting and Support at Humana

San Antonio, Texas, United States

Humana Logo
Not SpecifiedCompensation
Expert & Leadership (9+ years)Experience Level
Full TimeJob Type
UnknownVisa
Health Insurance, HealthcareIndustries

Requirements

Candidates must possess a Bachelor's Degree, over 5 years of managed care market operations experience, and more than 2 years of people leadership experience. Additionally, 2+ years of strong project management skills, 2+ years of hospital contracting negotiation experience or knowledge of facility payment/reimbursement methodologies, excellent communication skills, and experience presenting to senior leadership are required. Experience working successfully in a matrix environment and a flexible, dynamic personality are also necessary. Willingness and ability to travel up to 20% of the time is essential.

Responsibilities

The Director, Network Contracting and Support is responsible for supporting national and market-level provider relationships, focusing on improving the provider experience and achieving enterprise network optimization goals. This role oversees the strategic direction and operational oversight of the contract governance committee (CSA), contract language review (NLRG), and the Merlin/iCertis teams. They will serve as the national subject matter expert for hospital/IDN contracting/negotiation principles and integrating new IDNs. Responsibilities include the strategic development and implementation of operations, contract negotiations support, business ownership of CSA and like governance processes, and leading the National Language Resource Group (NLRG) team. The role involves collaborating with senior leadership and multiple enterprise departments to drive best practices in facility, IDN, and fee-for-service contracting, ensuring the resolution of development, expansion, and success of national contracting KPIs and Best Practices. They will develop and maintain market tools and resources to support contract negotiations and support the expansion and usage of the Merlin/iCertis contract management system, collaborating with enterprise partners for workflow optimization. The Director will manage a team of 6-10 direct reports.

Skills

Network Contracting
Provider Relations
Contract Negotiation
Operations Management
Strategic Planning
Process Improvement
Governance
Team Leadership
Cross-functional Collaboration

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters
1961Year Founded
IPOCompany Stage
Social Impact, HealthcareIndustries
10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.
Rising medical costs and tightening Medicare reimbursements may strain financial performance.
Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.
The company emphasizes inclusivity, offering free language interpreter services for accessibility.
Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.
The company is the first insurer to cover TMS therapy for adolescent depression.
Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

Land your dream remote job 3x faster with AI