Payer Strategy & Contracting Principal

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🔥 0 minutes ago

🌵 Arizona, California, +8 more states – Remote

🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🥔 Idaho – Remote 🦬 Montana – Remote 🎰 Nevada – Remote 🌲 Oregon – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ☕ Washington – Remote

💵 $138.9k - $191k / year

⏰ Full Time

🔴 Lead

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CenterWell Senior Primary Care

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

CenterWell Senior Primary Care is a healthcare provider focused on delivering personalized primary care to senior citizens. The company emphasizes a comprehensive and holistic approach to healthcare, addressing the physical, social, and emotional needs of older adults. As part of its service offerings, CenterWell includes home health services and pharmacy support to complement its senior primary care. The organization is committed to offering stability, inclusive benefits, and career growth opportunities for its employees while maintaining a culture of mutual respect and mindfulness. CenterWell is a brand under the larger healthcare entity, Humana.

📋 Description

• Develop and execute payer-specific and market-specific action plans aligned with enterprise payer strategy, growth priorities, and operational capacity • Evaluate payer opportunities using referral trends, membership and enrollment data, reimbursement, financial performance, market dynamics, operational capacity, and strategic fit • Analyze payer and market performance to identify growth opportunities, network gaps, underperforming agreements, renewal priorities, reimbursement opportunities, and termination risks • Develop recommendations on payer participation, contracting priorities, reimbursement strategies, and preferred provider opportunities • Lead development, negotiation, renewal, and amendment of national, regional, state, and local payer agreements • Evaluate reimbursement methodologies and contract terms • Develop financial analyses, business cases, rate recommendations, and contract feasibility assessments • Negotiate reimbursement, operational, administrative, and other material contract provisions • Coordinate stakeholder review, leadership approvals, agreement execution, renewal planning, and contractual milestones • Present contracting strategies, recommendations, risks, and business cases to leadership and governance forums • Lead cross-functional implementation of new and amended payer agreements • Establish implementation owners, deliverables, milestones, dependencies, and escalation pathways • Develop workflows, communications, reporting, and processes for payer agreement implementation • Resolve payer-related issues involving referrals, authorizations, eligibility, denials, payment, reimbursement, and contract requirements • Serve as primary business and contracting contact for assigned payer relationships • Conduct recurring payer business reviews focused on performance, operational issues, growth, quality, and strategic priorities • Expand network access, referral volume, preferred provider relationships, care coordination, quality initiatives, and value-based arrangements • Monitor payer and contract performance against negotiated terms, reimbursement assumptions, volume expectations, and financial measures • Identify reimbursement leakage, unfavorable trends, and operational performance drivers • Develop corrective action plans with Finance, Revenue Cycle, Operations, and other stakeholders • Assess financial impact of reimbursement changes and alternative payment methodologies • Provide leadership reporting and recommendations on contract performance, financial risks, growth opportunities, renewals, and corrective actions • Lead collaboration across Operations, Sales, Finance, Revenue Cycle, Clinical, Legal, Compliance, Business Development, and other stakeholders • Prepare business cases, recommendations, and decision materials for contracting and payer governance forums • Maintain contract documentation, decision records, action logs, implementation plans, and renewal milestones • Identify and escalate financial, operational, contractual, compliance, and implementation risks • Serve as a subject matter resource on payer relationships and contracting strategies

🎯 Requirements

• Bachelor’s degree in Business, Healthcare Administration, Finance, or a related field, or equivalent relevant professional experience • Five or more years of experience in managed care, payer contracting, provider relations, payer account management, healthcare finance, business development, or healthcare operations • Demonstrated experience interpreting payer agreements and reimbursement structures and leading contract negotiations • Strong financial acumen and ability to evaluate reimbursement methodologies, contract economics, and business cases • Strong analytical, negotiation, problem-solving, stakeholder management, and executive communication skills • Experience in home health, post-acute care, and/or managed care preferred • Knowledge of episodic, fee-for-service, and value-based reimbursement payment models, authorization requirements, and revenue cycle processes preferred • Experience leading complex initiatives across multiple functional and operational stakeholders preferred • Ability to manage multiple payer priorities, deadlines, negotiations, and implementation activities independently preferred • Experience with contract performance reporting, reimbursement analysis, and payer-provider issue resolution preferred • Experience presenting contracting strategies, business cases, and recommendations to senior leadership preferred • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • Dedicated workspace without ongoing interruptions to protect member PHI / HIPAA information

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Whole-person well-being and personal wellness support • Remote work arrangement • Occasional travel to Humana offices for training or meetings

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