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Humana · 3 days ago

Market VP, Provider Contracting

United States

Full-time

Remote

Mid, Senior Level

$185K/yr - $254K/yr

7+ years exp

Humana is a leading healthcare company focused on providing comprehensive health solutions. The Market VP of Provider Contracting will lead a team in negotiating reimbursement agreements and developing strategies for home health services, aiming to enhance value-based care models.

Health CareHealth InsuranceInsuranceVenture Capital

Responsibilities

Oversee payer negotiations end-to-end for home health services: develop strategy, serve as chief negotiator, and secure favorable rates and terms across commercial, Medicare Advantage, and Medicaid contracts, including fee-for-service, episodic, and value-based agreements

Set annual payment targets and portfolio strategy: define price/volume goals, prioritize payer opportunities, and construct multi-year contracting roadmaps to grow margin and access

Own contract economics and analytics: oversee financial modeling, valuation, scenario analyses, and pro formas to inform deal strategy and renewals

Advance value-based contracting: design and implement models such as shared savings, bundled/episodic payments, pay-for-performance, and new service models aligned to home-based care

Build payer relationships and multi-payer alignment: establish executive-level relationships with plan counterparts; align on quality measures, reporting, and health equity standards to reduce administrative burden and improve outcomes

Translate contracts into operations: partner with Revenue Cycle, Finance, Clinical, and Operations to implement terms (authorization, billing rules, payment integrity), monitor payer performance, and resolve disputes

Work closely with Compliance and Legal: manage the papering, review, and signature process for all payer agreements; ensure timely execution, adherence to regulatory requirements, and proper documentation of amendments and renewals

Develop internal contracting discipline: ensure timely document execution, renewals, amendments, and partner with credentialing as applicable

Oversee payer performance metrics: track payer scorecards (rates, denials, underpayments, turnaround times), VBC metrics (readmissions, utilization, home health quality measures), and overall portfolio results

Mentor and develop the team: coach contracting and managed care team members in negotiation tactics, modeling, compliance, and payer relationship management; foster a culture of transparency and results

Ensure compliance and risk management: coordinate with legal on contract language, regulatory updates, and accreditation requirements; monitor adherence to CMS and payer policies

Qualification

Payer contractingValue-based careFinancial modelingContract valuationNegotiation skillsLeadership experienceRelationship managementBachelor's degreeMaster's degree

Required

7+ years in payer or managed care contracting on the provider or plan side, including direct negotiation of reimbursement rates and contract terms; leadership experience managing a contracting team

Demonstrated expertise in value-based care, with hands-on design/implementation of alternative payment models (shared savings, bundles, pay-for-quality, capitation/PMPM), and familiarity with CMS value-based programs

Strong financial acumen: advanced proficiency in contract valuation, pricing analytics, and risk modeling; ability to translate clinical performance to economics and operational impacts

Relationship and influence skills: proven ability to build executive-level partnerships with health plans and internal leaders (Finance, Clinical, Ops, Revenue Cycle) to achieve contracting goals

Ability to translate contract performance into actionable insights for leadership

Education: Bachelor's degree required (Health Administration, Business, Finance, or related); Master's preferred (MBA/MHA)