Director Provider Contracting

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The Director, Provider Contracting serves as a strategic leader overseeing contracting activities for physician, hospital, and other provider agreements within two of the largest markets in Texas for a health insurance organization. This role leads a team of hospital and physician contracting professionals, guiding their work, setting clear objectives, and supporting professional growth and performance management. The Director is responsible for developing and executing market-specific contracting strategies, providing direction and oversight throughout the negotiation process, and actively participating in key negotiations with provider organizations.

The Director ensures that contracting initiatives are aligned with organizational goals and regulatory requirements, requiring an in-depth understanding of how capabilities interrelate across functions and segments. This position also fosters collaboration within the team and with internal stakeholders to drive successful outcomes and support the organization’s overall objectives.

The Director, Provider Contracting communicates contract terms, payment structures, and reimbursement rates to providers. Analyzes financial impact of contracts and terms. Maintains contracts and documentation within a tracking system. May assist with identifying and recruiting providers based on network composition and needs. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance.

Provides input into functions strategy.

• Bachelor's Degree or 8 years of combined leadership and contract negotiation experience
• Extensive provider contracting experience
• Proven leadership experience, including teambuilding
• Proven contract preparation skills, with an in-depth knowledge of Medicare and other reimbursement methodologies
• Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

• Master's or J.D. Degree
• Experience with ACO/Risk Contracting
• Value based contracting experience

This is a regional role. Candidates must reside within the designated region to be considered.

• WAH requirements:
  Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel:
While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

40

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$138,900 - $191,000 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings…