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Humana · 2 months ago

Regional VP Provider Contracting (Central Region)

Work at Home - South Dakota

Full-time

Onsite

Mid, Senior Level

$203K/yr - $280K/yr

7+ years exp

Humana is a Fortune 50 market leader in integrated healthcare delivery, dedicated to improving the health of the communities it serves. They are seeking a Regional Vice President for Provider Contracting to develop strategic provider relationships and lead efforts in provider engagement, contracting, and operations for the Central Region.

Health CareHealth InsuranceInsuranceVenture Capital

Responsibilities

Strategic Partner with all segments (Medicare, Group and Medicaid) accountable for developing and maintaining strategic network relationships with regional 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

Lead the transition of targeted membership and providers to engagement agreements

Work with potential joint ventures and other innovative partnership opportunities

Develop and lead efforts re: continuous improvement for unit cost strategy

Ensure access to care for members, network adequacy and gap closure

Participate with Medicare and Medicaid 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

Collaborate with internal partners to ensure best in class credentialing, contract load and directory accuracy

Incorporate provider feedback and practice perspective into strategy planning, development and operations; enhance the provider experience with Humana

Align regional and corporate goals and drive these goals into the provider practice leveraging clinical resources

Provide leadership to regional provider engagement, contracting, and operations teams

Ensure regional operations are in alignment with the company’s strategic objectives

Leverage talent and resources and champion a collaborative and integrated work environment. Lead initiatives to enhance productivity, develop talent, and change leadership

Qualification

Healthcare leadershipContract negotiationProvider relationship managementHealth plan financeRisk arrangements knowledgeTalent developmentCost control mechanismsMatrix organization navigationThought leadershipCommunication skills

Required

Bachelor's degree/Master's preferred

7 plus years leadership experience in the healthcare industry

5 plus years leading the end-to-end contract negotiation process through closure for all types of providers (physicians, hospitals, post-acute care facilities) and delegated specialty services

Comprehensive knowledge of health plan finance and the compensation arrangements between health plans and providers

Knowledge of risk arrangements and ability to influence these arrangements

Solid track record of hiring and developing talent and preparing associates for roles of broader and greater responsibility

The ability to identify health service expenses and implement cost control mechanisms within contracts

Experience identifying and recruiting providers to ensure network alignment with planned sales process execution, orienting providers and managing relationships, and driving improvement in provider satisfaction via education, communication and streamlining claims resolution

Recognition as a thought leader in the area of healthcare trend mitigation

Ability to effectively navigate and manage through a matrixed organizational environment in a large (Fortune 250) company

Excellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with audiences and positive representation of Humana in external forums