Provider Contracting Executive

Humana•Jacksonville, SC

2d•$94,900 - $130,500•Remote

About The Position

Humana Georgia is seeking a Provider Contracting Executive to support the development, negotiation, implementation, and management of provider network agreements across Georgia. The role builds and maintains relationships with hospitals, health systems, physician groups, ancillary providers, and other healthcare organizations to support Humana's Medicare Advantage and Medicaid network strategy, affordability goals, quality objectives, and member access requirements. The position reports to the Director, Provider Contracting. The Provider Contracting Executive leads complex contract negotiations, evaluates provider performance and market dynamics, and collaborates with internal business partners across network management, operations, finance, quality, clinical, and compliance functions. This is a remote position with occasional travel to Humana offices for training or meetings, as well as travel within Georgia as needed for provider meetings, department meetings, and market support. The position is scheduled for 40 hours per week.

Requirements

Bachelor's degree.
6+ years of progressive network management experience, including hospital contracting and network administration in a healthcare company.
2+ years of experience supporting providers in value-based arrangements.
Knowledge of provider reimbursement methodologies, including fee-for-service and value-based models.
Strong financial, analytical, and negotiation skills.
Experience presenting to senior leadership.
Proficiency with Microsoft Office applications, especially Excel and PowerPoint.
Ability to travel within Georgia as needed for provider meetings, department meetings, and market support.
Ability to meet remote-work internet requirements: at least 25 Mbps download and 10 Mbps upload; wireless, wired cable, or DSL connection is suggested.
Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information.

Nice To Haves

Experience in Medicare Advantage and Medicaid plan contracting.
Knowledge of the Georgia healthcare provider landscape.
Experience with value-based care arrangements and risk-based contracting.
Master's degree in business, healthcare administration, public health, or a related field.
Experience working across cross-functional teams in a large, highly regulated healthcare organization.

Responsibilities

Lead provider contracting activity for assigned markets, providers, and provider types within Georgia.
Negotiate and execute provider agreements, amendments, renewals, and terminations in alignment with enterprise network strategy.
Develop and maintain productive relationships with hospitals, physician organizations, ancillary providers, and health systems.
Resolve complex provider issues related to contract interpretation, escalations, and relationship management.
Analyze market conditions, provider performance, reimbursement structures, utilization trends, and competitive dynamics to support contracting strategy.
Partner with internal stakeholders to ensure provider contracts support affordability, quality, network adequacy, growth, and member access objectives.
Evaluate financial and operational impacts of proposed contract terms and reimbursement models.
Support implementation of value-based arrangements and alternative payment models where applicable.
Ensure contract terms comply with Humana policies, state and federal regulations, and internal governance requirements.
Collaborate with matrixed teams including legal, finance, network operations, credentialing, provider engagement, and clinical leadership.