Humana Georgia is seeking a Provider Contracting Executive to support the development, negotiation, implementation, and management of provider network agreements across Georgia. This role is responsible for building and maintaining strong relationships with hospitals, health systems, physician groups, ancillary providers, and other healthcare organizations to support Humana's Medicare Advantage and Medicaid network strategy, affordability goals, quality objectives, and member access requirements. You will report to the Director, Provider Contracting.
The Provider Contracting Executive will lead complex contract negotiations, evaluate provider performance and market dynamics, and collaborate with internal business partners across network management, operations, finance, quality, clinical, and compliance functions.
Key Responsibilities
- Lead provider contracting activity for assigned markets, providers, and provider types within Georgia
- Negotiate and execute provider agreements, amendments, renewals, and terminations in alignment with enterprise network strategy
- Develop and maintain productive relationships with hospitals, physician organizations, ancillary providers, and health systems
- Resolve complex provider issues related to contract interpretation, escalations, and relationship management
- Analyze market conditions, provider performance, reimbursement structures, utilization trends, and competitive dynamics to support contracting strategy
- Partner with internal stakeholders to ensure provider contracts support affordability, quality, network adequacy, growth, and member access objectives
- Evaluate financial and operational impacts of proposed contract terms and reimbursement models
- Support implementation of value-based arrangements and alternative payment models where applicable
- Ensure contract terms comply with Humana policies, state and federal regulations, and internal governance requirements
- Collaborate with matrixed teams including legal, finance, network operations, credentialing, provider engagement, and clinical leadership
Core Competencies
- Strategic negotiation
- Provider relationship management
- Market analysis
- Financial acumen
- Contract execution and oversight
- Collaboration and influence
- Regulatory and compliance awareness
- Problem-solving and decision-making
Use your skills to make an impact
Required Qualifications
- Bachelor's degree
- 6+ years of progressive network management experience including hospital contracting and network administration in a healthcare company
- 2+ years of supporting providers in value-based arrangements
- Knowledge of provider reimbursement methodologies, including fee-for-service and value based models
- Strong financial, analytical, and negotiation skills
- Experience presenting to Senior leadership
- Proficiency with Microsoft Office applications, especially Excel and PowerPoint
- Ability to travel within Georgia as needed for provider meetings, department meetings, and market support
Preferred Qualifications
- Experience in Medicare Advantage and Medicaid plan contracting
- Knowledge of the Georgia healthcare provider landscape
- Experience with value-based care arrangements and risk-based contracting
- Master's degree in business, healthcare administration, public health, or related field
- Experience working across cross-functional teams in a large, highly regulated healthcare organization
Additional Information
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from 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.
Scheduled Weekly Hours
40
Pay Range
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.
$94,900 - $130,500 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
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 plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
