[Remote] Provider Contracting Executive at Humana

Kentucky, United States

Apply Now

Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

U.S. citizenship
Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services)
Not currently 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
Experience presenting to varied audiences
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps (wireless, wired cable or DSL connection suggested; satellite, cellular and microwave only if approved)
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Responsibilities

Set VBC/APM contracting strategies within an assigned geographical region and execute upon said strategy
Communicate contract terms, payment structures, and reimbursement rates to providers
Analyze financial impact of contracts and terms
Maintain contracts and documentation within a tracking system
Assist with identifying and recruiting providers based on network composition and needs
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 cross-team with Actuary, Market Field Leadership, and Executive Council to ensure goals are met
Influence the field on which systems to partner with, provide sound contracting strategy, and develop contract templates
Work with senior executives on the development of functional strategies and provide recommendations on matters of significance
Exercise independent judgment and decision making on complex issues under nominal supervision
Employ strategic thinking and analysis of multiple factors to determine best course of action
Utilize latitude in determining task objectives and approaches to meet goals and deadlines

Skills

Key technologies and capabilities for this role

VBCAPMContract NegotiationProvider ContractingFinancial AnalysisContract ManagementStrategic PlanningRelationship ManagementHealthcare MetricsQuality GoalsCross-functional CollaborationActuarial Analysis

Questions & Answers

Common questions about this position

What qualifications are required for the Provider Contracting Executive role?

Candidates need a Bachelor's Degree, 5 years of experience with Value Based Contracting, 3 years of experience (incomplete in description), U.S. citizenship, and interim approval for government security clearance via NBIS.

Is U.S. citizenship required for this position?

Yes, U.S. citizenship is required due to the Department of Defense contract, along with interim approval for government security clearance through NBIS.

What is the employment type for this role?

The position is full-time.

Can candidates living in Puerto Rico apply for this position?

No, HGB is not authorized to hire candidates currently living in Puerto Rico due to the government contract.

What salary or compensation does this role offer?

This information is not specified in the job description.

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.

Land your dream remote job 3x faster with AI

Try Jobo Free