Director Provider Contracting

Profile

Description

Humana is a Fortune 60 market leader in integrated healthcare whose dream is to help people achieve lifelong well-being. As a company focused on the health and well-being of the people we serve, Humana starts from within, and is committed to providing progressive benefits that advance the employment experience and vitality of the associate community. Through 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.

Our wholly-owned affiliate, CarePlus, operates in 21 Florida counties, offering Medicare Advantage HMO plans that have been awarded 5-Star ratings by the Centers for Medicare and Medicaid Services in each of the past two years, and three of the past five years. CarePlus serves nearly 160,000 members within its operating footprint, and has been enjoying exponential growth in recent years.

Against that backdrop, CarePlus is seeking a talented healthcare/health insurance leader for the role of Director, Provider Contracting. The Director will be responsible for all contracting and servicing of providers in our Miami-Dade and Broward County markets. He/she will lead a multi-level team of 10-12 associates, and will report directly to a Market Vice President.

This position will be based either in our office in Doral.

Responsibilities

Key Responsibilities

Initiate, negotiate, and execute value-based Medicare Advantage contracts and agreements with physicians and other healthcare providers

Manage the provider relationship, ensuring that best-in-class servicing is delivered, including onboarding, training, issue resolution, etc.

Identify provider operational performance issues and potential gaps in patient care, and partner with providers on action plans to address those issues and to close gaps in care.

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

Identify and recruit providers based on network composition and needs.

Partner with the Market Vice President on creating growth strategies for the market.

Required Qualifications

8-10 years of experience working within healthcare

5 years of provider contracting experience to include complex negotiations

Proven leadership experience, including teambuilding

Value Based Contracting Experience in Medicare Advantage

Proven contract preparation skills, with an in-depth knowledge of Medicare and other reimbursement methodologies

Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena

Must live in, or be willing to move to, South Florida (Miami-Dade or Broward County)

Ability and willingness to travel within the region up to 15% of the time

Preferred Qualifications

Bachelor's Degree

Experience with ACO/Risk Contracting

Current or recent experience in the South Florida Market (Miami-Dade, Broward and Palm Beach County)

Bilingual (English-Spanish) strongly preferred

Additional Information

This position is considered remote/work at home, however, you must live within the South Florida region to be considered for this opportunity.

Work at Home Information

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

Satellite, cellular and microwave connection can be used only if approved by leadership

Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

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Scheduled Weekly Hours

40

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.

Company info

Humana Inc.
Website : http://www.humana.com