Provider Contracting Executive

🔥 16 hours ago

🐊 Florida, North Carolina, +1 more states – Remote

🐊 Florida – Remote 🌲 North Carolina – Remote 🌴 South Carolina – Remote

💵 $94.9k - $130.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Executive

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Lead provider contracting activity for assigned markets, providers, and provider types within Georgia • Negotiate and execute provider agreements, amendments, renewals, and terminations in alignment with enterprise network strategy • Develop and maintain relationships with hospitals, physician organizations, ancillary providers, and health systems • Resolve complex provider issues related to contract interpretation, escalations, and relationship management • Analyze market conditions, provider performance, reimbursement structures, utilization trends, and competitive dynamics • Partner with internal stakeholders on affordability, quality, network adequacy, growth, and member access objectives • Evaluate financial and operational impacts of proposed contract terms and reimbursement models • Support value-based arrangements and alternative payment models • Ensure contract terms comply with Humana policies, state and federal regulations, and internal governance requirements • Collaborate with legal, finance, network operations, credentialing, provider engagement, and clinical leadership teams • Report to the Director, Provider Contracting

🎯 Requirements

• Bachelor's degree • 6+ years of progressive network management experience, including hospital contracting and network administration in a healthcare company • 2+ years of supporting providers in value-based arrangements • Knowledge of provider reimbursement methodologies, including fee-for-service and value based models • Strong financial, analytical, and negotiation skills • Experience presenting to Senior leadership • Proficiency with Microsoft Office applications, especially Excel and PowerPoint • Ability to travel within Georgia as needed for provider meetings, department meetings, and market support

🏖️ 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 • Work-from-home arrangement • Occasional travel to Humana offices for training or meetings