Director, Provider Contracting
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AI Summary
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The Director, Provider Contracting initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements. The Director, Provider Contracting requires an in-depth understanding of how organization capabilities interrelate across the function or segment.The Director, Provider Contracting negotiates contract terms, payment structures, and reimbursement rates to providers across the state for both Medicare Advantage and Medicaid products. Able to work with detailed analytics to understand and communicate financial impact of contracts and terms. Works within multiple systems and tools to maintain contracts and contract details. Leads efforts with identifying and recruiting providers based on network composition and needs. Engagement and decision-making responsibilities related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes. Implements strategic plans, drives goals and objectives, supports operational improvement efforts, and improves performance. Leads contracting team and drives provider relationship.
Use your skills to make an impact
Required Qualifications
- Bachelor's Degree
- Extensive provider contracting experience
- Proven leadership experience, including teambuilding
- Proven contract preparation skills, with an in-depth knowledge of Medicare and other reimbursement methodologies
- Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena
- Must live within reasonable driving distance to the State of South Carolina and be willing and able to travel within the region, on occasion
Preferred Qualifications
- Master's or J.D. Degree
- Experience with ACO/Risk Contracting
- Value based contracting experience
Additional Information
This role is "remote/work at home", however, you must live within or in close proximity to the State of South Carolina to be considered for this opportunity. Minimal travel is expected, likely for team meetings or in-person provider meetings.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
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