[Remote] Provider Contracting Executive at Humana

San Antonio, Texas, United States

Humana Logo
Not SpecifiedCompensation
Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries

Requirements

  • 5 or more years of progressive network management experience including hospital, health system and large multi-specialty contracting in a healthcare company
  • Experienced in negotiating managed care contracts
  • Proficiency in analyzing, understanding, and communicating financial impact of contract terms, payment structures and reimbursement rates to providers
  • Excellent written and verbal communication skills
  • Ability to manage multiple priorities in a fast-paced environment
  • Proficiency in MS Office applications
  • Willing and able to work EST hours

Responsibilities

  • Initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements
  • Works on problems of diverse scope and complexity ranging from moderate to substantial
  • 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
  • Advises executives to develop functional strategies (often segment specific) on matters of significance
  • Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision

Skills

Key technologies and capabilities for this role

Provider ContractingManaged Care ContractsNetwork ManagementContract NegotiationFinancial AnalysisReimbursement RatesPayment StructuresMS OfficeACO ContractingValue Based Contracting

Questions & Answers

Common questions about this position

Is this role remote, and what are the location requirements?

This role is primarily remote/work at home, but requires working EST hours and occasional in-person meetings for provider meetings, training, or team events within the North Carolina region. Candidates should be comfortable traveling to these scheduled sessions as needed.

What are the required qualifications for this position?

Candidates need 5 or more years of progressive network management experience including hospital, health system and large multi-specialty contracting in a healthcare company, experience negotiating managed care contracts, proficiency in analyzing financial impacts of contracts, excellent communication skills, ability to manage multiple priorities, proficiency in MS Office, and willingness to work EST hours.

What is the salary or compensation for this role?

This information is not specified in the job description.

What preferred qualifications would make me stand out?

Preferred qualifications include a Bachelor's degree, experience with ACO/Risk Contracting, experience with Value Based Contracting, and ideally being located in North Carolina.

What internet requirements are needed for working from home?

A minimum download speed of 25 Mbps and upload speed of 10 Mbps is required, with wireless, wired cable or DSL suggested; satellite, cellular, and microwave connections need leadership approval. Employees in California, Illinois, Montana, or South Dakota receive a bi-weekly internet expense payment.

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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