Strategic Lead, Provider Network Transitions

Humana Inc; Hartford (CT); Remote; USD 139,000 - 191,000; Full time

Job summary

Humana Inc. is seeking a Principal, Provider Network Transition Strategy to lead enterprise-wide programs addressing provider network changes and disruption events.

This role partners across Contracting, Market Operations, Stars, Sales, Service, Compliance, and executive teams to assess risk and improve readiness. The position requires deep provider network expertise, executive presence, and the ability to influence outcomes in a matrixed environment.

Qualifications

• 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

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.

Skills

Provider contracting

Provider network management

Healthcare operations

Healthcare strategy

Cross-functional leadership

Executive communication

Data analytics

Travel readiness

Education

Bachelor's degree

Job description

Humana Inc. is seeking a Principal, Provider Network Transition Strategy to lead enterprise-wide programs addressing provider network changes and disruption events.

This role partners across Contracting, Market Operations, Stars, Sales, Service, Compliance, and executive teams to assess risk and improve readiness. The position requires deep provider network expertise, executive presence, and the ability to influence outcomes in a matrixed environment.