Director Provider Contracting-Behavioral Health Medicaid

Profile

Description

The Director, Provider Contracting- Behavioral Health Medicaid initiates, negotiates, and executes physician, hospital, and/or other provider behavioral health contracts for an organization that provides managed Medicaid health insurance. Requires an in-depth understanding of how organization capabilities interrelate across the Medicaid segment.

Responsibilities

The Director, Provider Contracting- Behavioral Health Medicaid communicates contract terms, payment structures, and reimbursement rates to behavioral health providers. Analyzes financial impact of contracts and terms. Maintains contracts and documentation within a tracking system. Will be responsible for leading a team that works with providers of behavioral/mental health services, specific to managed Medicaid line of business. May assist with identifying and recruiting providers based on network composition and needs. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy.

There are two openings for this position:

One requires more network operational experience

One requires more network development/RFP writing experience

Hiring leader will determine best fit based on skill set.

Dallas, TX is the preferred location for this position. Will consider remote for the right candid ate .

Required Qualifications

Bachelor's Degree

5 plus years provider contracting experience, 3 specific to behavioral health Medicaid

3 plus years leadership experience, including teambuilding

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 be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

Master's or J.D. Degree

Experience with ACO/Risk Contracting

Value based contracting experience

Additional Information

Scheduled Weekly Hours

40

Company info

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