VP, National Provider Network Management

Overview

Become a part of our caring community and help us put health first Humana is a $100+ billion (Fortune 38) market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong well-being. As a company focused on the health and well-being of the people we serve, Humana is committed to advancing the employment experience and vitality of the associate community.

Through offerings anchored in a whole-person view of human well-being, Humana embraces a focus on stimulating positive individual and population changes while nurturing a sense of security, enabling people to live life fully and be their most productive.

Against that backdrop, Humana is seeking an accomplished healthcare leader for the position of Vice President, National Provider Network Management. At a high level, this highly visible role will be responsible for defining the strategy for how we negotiate contracts with provider organizations. This position will foster the development of national strategic provider relationships and networks that help advance Humana's strategy and goals toward improving the health of the communities we serve.

The Vice President will also provide executive leadership to the National Contracting, Ancillary Contracting, Behavioral Health Contracting and Provider Analytics teams in support of Humana's Insurance Business.

This position reports to the Senior Vice President, National Provider and Service Operations and will lead an organization of 300+ associates with seven direct reports.

• Develop and lead national provider network strategy across Medicare and Medicaid segments, including but not limited to Integrated Delivery Networks, Specialty payment innovation, Ancillary providers, Behavioral Health and the post acute delivery network.
• Strategic Partner with all segments of Humana's Insurance Business, accountable for developing and maintaining strategic network relationships with large national providers. Ensure adequate coverage of primary care, specialty and ancillary services for Humana to meet both regulatory and sales support need.
• Align strategy and priority between different segments/functions and be the defined point of contact for escalated provider engagements and issues.
• Establish enterprise wide contracting standards, best practices and policies for Medicare and Medicaid lines of business. Collaborate across departments and market teams to implement those practices.
• Lead Enterprise change efforts regarding contract standardization, creating simplified processes and policies for our contractors and providers. Ensure access to care for members, network adequacy and gap closure.
• Develop and lead trend initiatives with key providers and partners.
• Executive leadership of Provider Performance and Analytics functions, supporting Humana's value-based contracts and trend bender initiatives.
• Manage across a highly matrixed organization aligning priorities and results at a national and regional level.
• Provide leadership to a team of executives and their staff, driving associate engagement initiatives, developing and managing talent, and leading change efforts.

• Bachelor's degree
• 10 plus years contracting and/or managing relationships with Integrated Delivery Systems.
• 6 plus years business leadership experience, with several years in a managed care environment leading a network development/provider relations function, including proven experience leading contracting for Medicare and Medicaid products.
• Experience leading the "end-to-end" contract negotiation process through closure for different types of providers (hospitals, physicians, sub-acute care facilities) pharmacy networks and delegated specialty services across all health insurance product lines.
• Proven skill in driving results, thinking strategically and executing strategy effectively; thinking at an enterprise level.
• Knowledge of risk arrangements and ability to influence these arrangements
• Record of success leading the delivery of large, enterprise-scale initiatives involving multiple functions and business segments
• Strong relationship management skills, to teach, tailor, and take control of opportunity definition and initiation with business partners
• Proven results in building teams and strong culture leader
• Comprehensive knowledge of health plan finance and the compensation arrangements between health plans and providers, including plan funding, risk management and provider reimbursement.

• MBA and/or JD degree
• The ability to identify health service expenses and implement cost control mechanisms within contracts.
• Prior executive leadership experience in sales, finance, legal, health services, and/or medical management; demonstrated ability to partner across functions to create and deploy win/win strategies.
• Executive leadership experience, setting vision and goals, aligning talent, developing teams, leading positively and leading through change
• Recognition as a thought…