Regional VP Provider Contracting (Central Region)

Humana

3d

About The Position

Become a part of our caring community and help us put health first Humana is a Fortune 50 market leader in integrated healthcare delivery. As a company whose primary focus is on the well-being of its members, Humana is dedicated to shifting perceptions of the health insurance industry. We believe our role goes beyond that of an insurer to that of a well-being partner. Through product and service offerings anchored in a whole person view of human well-being, Humana embraces a focus on stimulating positive individual and population changes while nurturing a sense of security, enabling people to live life fully and be their most productive. Against that backdrop, Humana is seeking an accomplished healthcare leader for the position of Regional Vice President, Provider Contracting. The Regional Vice President will foster the development of strategic provider relationships for all product lines in the Central Region, encompassing KS, MO, IA, NE, IL, WI, MN, ND and SD. This position will develop provider networks that help advance Humana’s strategy and goals toward improving the health of the communities we serve. The Regional Vice President will also provide executive leadership to Provider Contracting, Provider Education and Provider Engagement in support of Humana’s Group, Medicare, and Medicaid lines of business. This position reports to the Central Region President and will need to reside within the Region. 20% travel within the region can be expected

Requirements

• Bachelor’s degree/Master’s preferred
• 7 plus years leadership experience in the healthcare industry
• 5 plus years leading the end-to-end contract negotiation process through closure for all types of providers (physicians, hospitals, post-acute care facilities) and delegated specialty services.
• Comprehensive knowledge of health plan finance and the compensation arrangements between health plans and providers
• Knowledge of risk arrangements and ability to influence these arrangements.
• Solid track record of hiring and developing talent and preparing associates for roles of broader and greater responsibility.
• The ability to identify health service expenses and implement cost control mechanisms within contracts.
• Experience identifying and recruiting providers to ensure network alignment with planned sales process execution, orienting providers and managing relationships, and driving improvement in provider satisfaction via education, communication and streamlining claims resolution.
• Recognition as a thought leader in the area of healthcare trend mitigation.
• Ability to effectively navigate and manage through a matrixed organizational environment in a large (Fortune 250) company.
• Excellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with audiences and positive representation of Humana in external forums

Responsibilities

• Strategic Partner with all segments (Medicare, Group and Medicaid) accountable for developing and maintaining strategic network relationships with regional providers.
• Ensure adequate coverage of primary care, specialty and ancillary services for Humana to meet both regulatory and sales support need.
• Align strategy and priority between different segments/functions and be the defined point of contact for escalated provider engagements and issues.
• Lead the transition of targeted membership and providers to engagement agreements.
• Work with potential joint ventures and other innovative partnership opportunities.
• Develop and lead efforts re: continuous improvement for unit cost strategy.
• Ensure access to care for members, network adequacy and gap closure.
• Participate with Medicare and Medicaid trend initiatives with key providers and partners.
• Executive leadership of Provider Performance and Analytics functions, supporting Humana’s value-based contracts and trend bender initiatives.
• Collaborate with internal partners to ensure best in class credentialing, contract load and directory accuracy
• Incorporate provider feedback and practice perspective into strategy planning, development and operations; enhance the provider experience with Humana.
• Align regional and corporate goals and drive these goals into the provider practice leveraging clinical resources.
• Provide leadership to regional provider engagement, contracting, and operations teams.
• Ensure regional operations are in alignment with the company’s strategic objectives.
• Leverage talent and resources and champion a collaborative and integrated work environment.
• Lead initiatives to enhance productivity, develop talent, and change leadership.

Benefits

• Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Executive
• Number of Employees: 5,001-10,000 employees