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Provider Contracting Executive – Georgia (Remote)
Lead provider negotiations and network relationships across Georgia for Humana. Support Medicare Advantage and Medicaid networks through reimbursement analysis and value-based contracting.
Apraksts
- Oversee provider contracting across assigned Georgia markets and provider groups.
- Negotiate and finalize provider agreements, amendments, renewals, and terminations in line with Humana’s network strategy.
- Build and sustain relationships with hospitals, physician organizations, ancillary providers, and health systems.
- Address complex contract interpretation, escalations, and provider relationship issues.
- Assess market conditions, provider performance, reimbursement structures, utilization trends, and competition.
- Coordinate with internal partners to advance affordability, quality, network adequacy, growth, and member access.
- Assess the financial and operational effects of proposed contract terms and reimbursement models.
- Help develop value-based agreements and alternative payment models.
- Confirm contract terms meet Humana policies, applicable state and federal regulations, and internal governance standards.
- Work with legal, finance, network operations, credentialing, provider engagement, and clinical leadership teams.
- Report to the Director of Provider Contracting.
Prasības
- Bachelor’s degree.
- At least 6 years of progressive network management experience, including hospital contracting and network administration at a healthcare company.
- At least 2 years supporting providers in value-based arrangements.
- Knowledge of provider reimbursement approaches, including fee-for-service and value-based models.
- Strong financial, analytical, and negotiation abilities.
- Experience presenting to senior leaders.
- Proficiency with Microsoft Office, particularly Excel and PowerPoint.
- Ability to travel within Georgia as needed for provider meetings, department meetings, and market support.
Priekšrocības
- Bonus incentive plan tied to company and/or individual performance.
- Medical coverage.
- Dental coverage.
- Vision coverage.
- 401(k) retirement savings plan.
- Paid time off.
- Company holidays.
- Personal holidays.
- Paid parental leave.
- Paid caregiver leave.
- Short-term disability coverage.
- Long-term disability coverage.
- Life insurance.
- Work-from-home arrangement.
- Occasional travel to Humana offices for training or meetings.