Provider Network Manager
Devoted HealthFull Time
Senior (5 to 8 years)
Candidates must have 5 or more years of progressive contracting experience for a national health plan and 2 or more years of experience leading people or projects. A strong financial acumen with proficiency in analyzing and interpreting financial trends in provider contracting, proven contract preparation skills with in-depth knowledge of Medicare and other reimbursement methodologies, and excellent written and verbal communication skills are required. Proficiency in Microsoft Office applications (Excel, Word, PowerPoint, Outlook) and the ability to manage multiple priorities in a fast-paced environment are also necessary. Candidates must reside within the State of Florida and be willing to travel within the region as required. A Bachelor's Degree, experience with ACO/Risk Contracting, value-based contracting experience, and Medicaid experience are preferred.
The Manager, Provider Contracting initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements. This role oversees a team of Provider Contracting Professionals responsible for Direct Agreements (Medicare HMO and Medicaid), communicating contract terms, payment structures, and reimbursement rates to providers. Responsibilities include analyzing the financial impact of contracts, maintaining contracts and documentation within a tracking system, and potentially assisting with identifying and recruiting providers. The role requires cross-departmental collaboration and conducting briefings and area meetings.
Health insurance provider for seniors and military
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.