Humana este o companie de servicii medicale și asigurări de sănătate axată pe îmbunătățirea rezultatelor în materie de sănătate pentru persoane, comunități și sistemul de sănătate în ansamblu. Activitatea sa include planuri Medicare Advantage de tip HMO, PPO și PFFS, destinate unor categorii de populație precum persoanele vârstnice și membrii forțelor armate. Humana pune, de asemenea, accent pe un mediu de lucru incluziv, construit pe sentimentul de apartenență, respect reciproc și oportunități pentru angajați de a contribui la misiunea companiei axată pe sănătate.
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.
Descriere
- 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.
Cerințe
- 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.
Beneficii
- 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.