[Remote] Provider Contracting Executive at Humana

Kentucky, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

U.S. citizenship
Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services)
Not living in Puerto Rico
Bachelor's Degree
5 years of experience with Value Based Contracting
3 years of experience with provider contracting skills including contract preparation and implementation
Strong financial acumen with proficiency in analysis of rate proposal development
Ability to present to varied audiences
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps for work at home requirements

Responsibilities

Develop contracting methodologies and foster relationships with large hospital systems
Maintain metrics and health quality based goals to meet and exceed for providers to gain additional payments
Collaborate with cross-functional teams to ensure goals are met
Influence the field in terms of which systems to partner with and provide sound contracting strategy
Develop contract templates
Negotiate contracts
Analyze financial impact of contracts and terms
Maintain contracts and documentation within a tracking system
Communicate contract terms, payment structures, and reimbursement rates to providers
Assist with analysis and recruitment of providers based on network deficiencies, composition and needs
Work with senior executives on the development of functional strategies
Provide recommendations to senior executives on matters of significance
Exercise independent judgment and decision making on complex issues
Employ strategic thinking and analysis of multiple and variable factors to determine the best course of action

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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