Principal, Provider Network Transition Strategy

Humana

4d • $138,900 - $191,000 • Remote

About The Position

The Principal, Provider Network Transition Strategy serves as an enterprise leader responsible for developing and advancing Humana's strategy for significant provider network changes and disruption events. This highly visible individual contributor role partners across Provider Contracting, Market Operations, Member Experience, Stars, Sales, Service, Compliance, and executive leadership teams to assess risk, develop mitigation strategies, and improve organizational readiness related to provider network transitions.

The Principal leads complex, enterprise-wide initiatives that influence member access, provider experience, business performance, and operational outcomes. Success in this role requires deep provider network expertise, strong executive presence, and the ability to drive results through influence in a highly matrixed environment where execution is performed across multiple business areas.
The Principal, Provider Network Transition Strategy is responsible for leading strategic programs that support Humana's readiness and response to provider network changes, including provider terminations, large-scale provider transitions, and other events impacting member access and provider relationships.
As a recognized enterprise subject matter expert, this role works across organizational boundaries to identify risks, improve business processes, and build a Provider Network Transitions Program that enhance the provider, member, and associate experience. The Principal partners closely with senior leaders to evaluate operational, regulatory, financial, and member impacts while helping the organization execute coordinated responses to provider network change.
This role does not directly own operational execution. Instead, the Principal drives enterprise alignment, facilitates decision-making, and influences outcomes through partnership with leaders across multiple business functions.

Requirements

• 7+ years of experience in provider contracting, provider network management, healthcare operations, healthcare consulting, or related healthcare strategy roles
• 3+ years of project, program, or people leadership experience
• Strong understanding of provider network operations, provider contracting strategy, healthcare delivery systems, and payer-provider relationships in a Medicare Advantage and/or Medicaid environment
• Demonstrated experience leading large-scale, cross-functional initiatives that require collaboration across multiple business areas
• Experience influencing leaders and driving results in a matrixed environment without direct authority over execution teams
• Experience utilizing data and analytics to drive business decisions and executive-level recommendations
• Proven ability to communicate effectively with senior leaders and executive stakeholders
• Ability and willingness to travel up to 10%
• Must reside within the Central or Eastern Time Zone

Nice To Haves

• Bachelor's degree
• Experience navigating complex regulatory, operational, and member experience considerations within a health plan environment

Responsibilities

• Lead Humana's enterprise strategy for provider network transition and disruption management initiatives, including assessment of member, provider, operational, regulatory, and business impacts.
• Serve as the enterprise lead for provider termination and provider network transition programs, ensuring cross-functional alignment and organizational readiness.
• Partner with Provider Contracting, Market Leadership, Member Retention, Stars, Provider and Member Service, Compliance, Provider Network Operations, and other key stakeholders to develop and implement mitigation strategies.
• Proactively identify emerging provider network risks and opportunities, developing recommendations for senior leadership regarding readiness, response, and enterprise prioritization.
• Drive initiatives that improve provider and member experiences during periods of provider network change while reducing operational friction and execution risk.
• Facilitate executive governance and decision-making processes related to provider network transitions and enterprise risk mitigation.
• Develop and maintain enterprise visibility into significant provider network events through reporting, analytics, executive communications, and performance monitoring.
• Utilize data and business insights to evaluate downstream impacts of provider network changes on member retention, access to care, network adequacy, Stars performance, service operations, and overall business performance.
• Lead cross-functional efforts to simplify processes, improve coordination across teams, and strengthen enterprise capabilities related to provider network transitions.
• Influence leaders and stakeholders across a matrixed organization to drive accountability, remove barriers, and achieve desired business outcomes without direct operational ownership.
• Advise senior leaders and executives on strategic initiatives, organizational risks, and opportunities related to provider network change management.
• Identify and prioritize future opportunities that enhance Humana's ability to effectively manage provider network transitions and disruption events.

Benefits

• medical
• dental
• 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: Principal
• Education Level: Associate degree