The Director, Provider Contracting initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Director, Provider Contracting requires an in-depth understanding of how organization capabilities interrelate across thefunction or segment.
The Director of Provider Contracting and Operations will lead and manage the development of Humana’s Northeast Region provider contracting and operations in the Upstate New York and New England market. The Director will drive strategic initiatives within the provider network and ensure that the alignment of departmental objectives is congruent with the overall business strategy. Primary responsibilities include:
- Initiating and maintaining productive long-term relationships with Hospitals and provider groups in the market.
- Developing effective relationships with the Northeast Region functional areas to drive success in Network and Regional initiatives
- Providing effective operations management, ensuring that all contracts are within required guidelines and financial parameters, and maintain current provider data within payment systems
- Applying economic and strategic planning models to all endeavors in your region in order to align business, process, and operational principles with area-specific goals
Business and Financial Acumen, Acts Strategically, Collaborates, Lead Positively, strong work ethic, Operations , Human capital/management experience, understanding the technical aspects of contract operationalization
- Bachelor’s Degree in Business, Finance or a related field; or a minimum of 10 years’ provider contracting experience to include hospital contracting
- A minimum of 5 years contracting experience
- Solid leadership/management experience including supervisory and teambuilding
- Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena
- Proven contract preparation and negotiation skills, with an in-depth knowledge of Medicare contracting including Value Based/ Incentive contracting experience.
- Master’s Degree in Business Administration or Finance
- Experience with ACO/Risk Contracting
- 3+ years of Contracting experience for a national health plan
Scheduled Weekly Hours