Senior Hospital Contracting Negotiator

Humana Inc; Augusta (ME); Remote; USD 78,000 - 108,000; Full time

Job summary

Humana Inc. is seeking a Senior Hospital Contracting Strategist/Negotiator to initiate, negotiate, and execute hospital and provider contracts. You will report to the Director, Provider Contracting and lead negotiations for hospital agreements, including reimbursement and value-based arrangements.

The role requires 5+ years in hospital negotiation, Medicare experience, and strong financial analysis, with travel as needed; remote work option with 40-hour weeks and a competitive base pay.

Qualifications

• Bachelor's degree.
• 5+ years hospital negotiation experience in Medicare.
• 5+ years progressive network management experience including hospital contracting and network administration.
• Experience negotiating managed care contracts with Hospital systems including post acute, ancillary providers and physicians.
• Analyze, understand and communicate financial impact of contract terms, payment structures and reimbursement rates to providers.
• Understand and interpret Hospital contract language.
• Proficient in Microsoft Office: Word, Excel and PowerPoint.

Responsibilities

• Lead negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value based agreements.
• Extensive managed care experience with expertise in hospital contracting, reimbursement methodologies, financial analysis, complex negotiations, provider relationship management, and leadership.
• Experience with Medicare Advantage, Medicaid, and value based-contracting.
• Evaluate reimbursement methodologies, including DRG, PD, Case Rates, POC, OP fee schedules, and alternative payment arrangements.
• Partner with Finance, Medical Economics, Legal, Network Management, Claims, Configuration, and Operations to ensure contracts are financially sound and operationally executable.
• Communicate contract terms, payment structures, and reimbursement rates to providers.
• Analyze financial impact of contracts and terms.
• Maintain contracts and documentation within a tracking system.
• Help with identifying and recruiting providers based on network composition and needs.

Skills

Hospital negotiation

Contract negotiation

Value based contracting

Financial analysis

Provider relationship management

Medicare

Reimbursement methodologies

DRG/PD/Case rates

Contract language

Microsoft Office

Education

Bachelor's degree

Master's degree

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Job description

Become a part of our caring community

The Senior Hospital Contracting Strategist / Senior Hospital Contracting Negotiator/ Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital and other provider contracts and agreements for an organization that provides health insurance. You will report to the Director, Provider Contracting.

As the Senior Hospital Contracting Negotiator /Senior Hospital Contracting Strategist/ Senior Provider Contracting Professional you will

• Lead negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value based agreements
• Extensive managed care experience with demonstrated expertise in hospital contracting, reimbursement methodologies, financial analysis, complex negotiations, provider relationship management, and leadership
• Experience with Medicare Advantage, Medicaid, and value based-contracting
• Evaluate reimbursement methodologies, including DRG, PD, Case Rates, POC, OP fee schedules, and alternative payment arrangements
• Partner with Finance, Medical Economics, Legal, Network Management, Claims, Configuration, and Operations to ensure contracts are financially sound and operationally executable
• Communicate contract terms, payment structures, and reimbursement rates to providers
• Analyze financial impact of contracts and terms
• Maintain contracts and documentation within a tracking system
• Help with identifying and recruiting providers based on network composition and needs

Use your skills to make an impact

Required Qualifications

• Bachelor's degree
• 5 or more years of Hospital negotiation experience in Medicare
• Leading negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value based agreements
• 5 or more years of progressive network management experience including hospital contracting and network administration in a healthcare company
• Experienced in negotiating managed care contracts with Hospital systems inclusive of post acute, ancillary providers and physicians.
• Analyze, understand and communicate financial impact of contract terms, payment structures and reimbursement rates to providers.
• Understand and interpret Hospital contract language
• Proficient in Microsoft Office: Word, Excel and PowerPoint

Preferred Qualifications

• Master's Degree
• Experience with ACO/Risk Contracting
• Experience with Value Based Contracting

Additional Information

8am to 5pm EST, Travel based on business needs

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$78,400 - $107,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.

Application Deadline: 10-30-2026

About us

About CarePlus Health Plans: CarePlus Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to help people with Medicare, or both Medicare and Medicaid, achieve their best possible health and wellness through plans with benefits and services they care about. As a wholly owned subsidiary of Humana, CarePlus currently serves Medicare beneficiaries throughout 21 Florida counties.

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.