Director, Provider Contracting
Humana
**Become a part of our caring community and help us put health first**
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 18 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 Multi Counties in the market. He/she will lead a multi-level team of 10-12 associates and will report directly to a Market Vice President.
**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.
**Use your skills to make an impact**
**Required Qualifications**
+ 5+ years of progressive experience with provider contracting
+ 5+ years of Proven leadership experience, including team building
+ 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 the North/Central region of the State of Florida
**Preferred Qualifications**
+ Bachelor's Degree
+ Experience with Specialty/Ancillary contracting
+ Experience with ACO/Risk Contracting
+ Value based contracting experience
**Additional Information**
This role is "remote/work at home", however, you must live in the North/Central region of the state of Florida to be considered for this opportunity.
**Work at Home Information**
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.
+ Satellite, cellular and microwave connection can be used only if approved by leadership.
+ Employees 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 employees 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.
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.
$138,900 - $191,000 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
**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 committed to putting health first – for our teammates, our customers, and our 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, Medicaid, families, individuals, military service personnel, and communities at large.
**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.
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