[Remote] Director, Provider Contracting at Humana

South Carolina, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Bachelor's Degree
8+ years of progressive experience in provider contracting to include all provider types (hospital, IDN, physician, ancillary)
Proven leadership experience, including team building
Proven contract preparation skills, with an in-depth knowledge of Medicare and other reimbursement methodologies
Value-based contracting experience
Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena
Ability to work from home with a reliable internet connection
Ability to travel occasionally to Humana's offices for training or meetings

Responsibilities

Initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements
Communicates contract terms, payment structures, and reimbursement rates to providers
Analyzes financial impact of contracts and terms
Maintains contracts and documentation within a tracking system
May assist with identifying and recruiting providers based on network composition and needs
Implements strategic plans, drives goals and objectives, and improves performance
Provides input into functions strategy

Skills

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.

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