Director, Provider Contracting

Humana • Work at Home - South Carolina, SC

1d • $138,900 - $191,000 • Remote

About The Position

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.

Requirements

• 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

Nice To Haves

• Master's or J.D. Degree
• Experience with ACO/Risk Contracting
• Value based contracting experience

Responsibilities

• Initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements.
• Negotiates contract terms, payment structures, and reimbursement rates to providers across the state for both Medicare Advantage and Medicaid products.
• Works 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.

Benefits

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Director