Remote Senior Provider Contracting Lead — Value-Based

Humana, Inc.; Madison (WI); Remote; USD 78,000 - 108,000; Full time

Job summary

Humana, Inc. seeks a Senior Provider Contracting Professional to lead contracting for the Central Region, initiating, negotiating and executing physician, hospital and other provider agreements to support value-based care and member access.

You will report to the Director, Provider Contracting, collaborate with legal, finance, network operations and clinical leadership, and ensure contracts comply with Humana policies and regulations. Some travel may be required.

Qualifications

• Bachelor's degree required.
• 5+ years progressive network management including hospital contracting and network administration.
• Experience negotiating managed care contracts with large physician groups and hospitals.
• Ability to analyze financial impact of contract terms and reimbursement rates.
• Proficiency with MS Office applications.

Responsibilities

• Lead provider contracting activity for assigned markets, providers, and provider types.
• Negotiate and execute provider agreements, amendments, renewals, and terminations.
• Develop and maintain relationships with physicians, provider groups, ancillary providers and hospitals.
• Resolve complex provider issues related to contract interpretation and relationship management.
• Collaborate with internal stakeholders to ensure contracts support affordability, quality, and access.
• Evaluate financial and operational impacts of proposed contract terms and reimbursement models.
• Support value-based arrangements and quality rewards programs where applicable.
• Ensure contract terms comply with Humana policies, state and federal regulations, and governance.
• Collaborate with legal, finance, network operations, credentialing, provider engagement, and clinical leadership.

Skills

Contract negotiation

Financial analysis

Provider contracting

Relationship management

MS Office

Education

Bachelor's degree

Master's degree

Job description

Humana, Inc. seeks a Senior Provider Contracting Professional to lead contracting for the Central Region, initiating, negotiating and executing physician, hospital and other provider agreements to support value-based care and member access.

You will report to the Director, Provider Contracting, collaborate with legal, finance, network operations and clinical leadership, and ensure contracts comply with Humana policies and regulations. Some travel may be required.