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Description

The Director, Provider Contracting, leads and manages the provider networks for all of Humana’s various lines of business through the NC Contracting team. The Director also initiates, analyzes, and negotiates hospital, physician, and/or other provider contracts and agreements for the organization; including value-based arrangements directly with provider groups and integrated systems. The Director, Provider Contracting requires an in-depth understanding of contracting, reimbursement methodology, and financial acumen. The role requires close collaboration with various internal departments and leaders to obtain consensus and ensure the successful execution of contracts and continued provider relationships. The position coordinates the contracting functions with other key Humana areas such as Provider Engagement, Network Operations for contract loads, National Contracting, and other functional leaders across the organization.

Responsibilities

  • Lead, mentor, and manage a team of contracting professional, fostering a collaborative and high-performance work environment.

  • Develop and execute strategic plans for contracting with hospital, physician, ancillary, and valued-based providers.

  • Negotiate contract terms, pricing, and conditions with healthcare providers to secure favorable agreements.

  • Ensure all contracts comply with company policies, regulatory requirements, and industry standards.

  • Collaborate with internal leaders across departments to obtain necessary approvals and align contracting strategies with organizational goals.

  • Monitor and evaluate the performance of contracted providers, ensuring high quality care and service delivery.

  • Maintain comprehensive documentation and records of all contracts and negotiations.

  • Stay informed about industry trends, regulatory changes, and competitive landscape to inform contracting strategies.

  • Address and resolve any issues or disputes related to contracts in a timely and effective manner.

  • Provide regular reports and updates to senior management on contracting activities, performance, and outcomes.

  • Other duties as assigned by senior leadership.

Required Qualifications

  • Bachelor's Degree
  • 5+ years of successfully negotiating and managing contracts with hospitals, physicians, and ancillary providers.
  • 3+ years of leadership and team management skills, with the ability to motivate and develop staff.
  • Contract preparation, negotiation, and execution skills, with an in-depth knowledge of Medicare and other reimbursement methodologies
  • Value based contracting experience
  • Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena
  • Excellent communication and interpersonal skills, with the ability to collaborate effectively with internal and external stakeholders.
  • Strategic thinker with strong analytical and problem-solving abilities.
  • Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
  • Proven track record of accomplishing targets and goals
  • Ability and willingness to travel within the region, as required

Preferred Qualifications

  • Master's or J.D. Degree
  • Experience with ACO/Risk Contracting

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Additional Information

This position is considered "remote/work at home", however you must be within commutable distance from North Carolina providers.

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 recommended; 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

#LI-Remote

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Scheduled Weekly Hours

40



Request an Accommodation

If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact yourcareer@humana.com for assistance.

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Our Hiring Process

Apply online

To be considered for a job, you must apply online. Unfortunately, we cannot accept resumes that have been emailed to us. Once you find a job that interests you, simply select “Apply.” It typically takes 15 minutes to fill out the application form. Be sure to update your resume and upload it as you cannot edit the resume or add it after the application has been submitted. Shortly after you submit your application, you will receive a confirmation.

Next Step

If selected to continue with the interview process, you will be contacted through text or email to complete an assessment or schedule an initial live or recorded phone or video interview.

A hiring manager interview

After hiring managers and interview teams carefully consider the skills and experiences of applicants, they contact the top candidates via email or phone to schedule an interview.

Offer from Humana

If you’ve successfully completed the interview process and are identified as the candidate we would like to hire, you will receive an offer from our Talent Acquisition team.

Onboarding

If you accept the offer to join our Humana team, you will receive a welcome call or email to begin the onboarding process.


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Hiring Process