Director, Provider Contracting

Employment Type: Full time

Position Overview

Humana, a Fortune 60 market leader in integrated healthcare, is seeking a talented healthcare/health insurance leader for the role of Director, Provider Contracting within its wholly owned affiliate, CarePlus. CarePlus operates in 18 Florida counties, offering highly-rated Medicare Advantage HMO plans. The Director will be responsible for all contracting and servicing of providers in our Multi Counties in the market. This role offers the opportunity to become part of a caring community dedicated to helping people achieve lifelong well-being.

Key Responsibilities

• Initiate, negotiate, and execute value-based Medicare Advantage contracts and agreements with physicians and other healthcare providers.
• Manage provider relationships, ensuring best-in-class servicing, including onboarding, training, and issue resolution.
• Identify provider operational performance issues and potential gaps in patient care, partnering with providers on action plans to address these issues and close gaps in care.
• Communicate contract terms, payment structures, and reimbursement rates to providers.
• Analyze the financial impact of contracts and terms.
• Maintain contracts and documentation within a tracking system.
• Identify and recruit providers based on network composition and needs.
• Partner with the Market Vice President on creating growth strategies for the market.

Requirements

• 5+ years of progressive experience with provider contracting.
• 5+ years of proven leadership experience, including team building.
• Proven contract preparation skills, with an in-depth knowledge of Medicare and other reimbursement methodologies.
• Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena.
• Must live in the North/Central region of the State of Florida.

Preferred Qualifications

• Bachelor's Degree.
• Experience with Specialty/Ancillary contracting.
• Experience with ACO/Risk Contracting.
• Value-based contracting experience.

Work at Home Information

This role is "remote/work at home". To be considered, you must live in the North/Central region of the state of Florida.

Internet Service Requirements:

• Minimum download speed of 25 Mbps and upload speed of 10 Mbps.
• Wireless, wired cable, or DSL connection is suggested.
• Satellite, cellular, and microwave connections may be used only if approved by leadership.
• Employees in California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for internet expenses.

Additional Information:

• Humana will provide appropriate telephone equipment.
• Employees must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• Travel: While the role is remote, travel may be required.