Become a part of our caring community and help us put health first
 

Humana is a Fortune 60 market leader in integrated healthcare whose dream is to help people achieve lifelong well-being. As a company focused on the health and well-being of the people we serve, Humana starts from within, and is committed to providing progressive benefits that advance 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.

Our wholly-owned affiliate, CarePlus, operates in 21 Florida counties, offering Medicare Advantage HMO plans that have been awarded 5-Star ratings by the Centers for Medicare and Medicaid Services in each of the past two years, and three of the past five years. CarePlus serves nearly 160,000 members within its operating footprint, and has been enjoying exponential growth in recent years.

Against that backdrop, CarePlus is seeking a talented healthcare/health insurance leader for the role of Director, Provider Contracting. The Director will be responsible for all contracting and servicing of providers in our Miami-Dade and Broward County markets. He/she will lead a multi-level team of 10-12 associates, and will report directly to a Market Vice President.

This position will be based either in our office in Doral.

Key Responsibilities

• Initiate, negotiate, and execute value-based Medicare Advantage contracts and agreements with physicians and other healthcare providers 
• Manage the provider relationship, ensuring that best-in-class servicing is delivered, including onboarding, training, issue resolution, etc.
• Identify provider operational performance issues and potential gaps in patient care, and partner with providers on action plans to address those issues and to close gaps in care.
• Communicate contract terms, payment structures, and reimbursement rates to providers. 
• Analyze financial impact of contracts and terms 
• Maintain contracts and documentation within a tracking system
• Identify and recruit providers based on network composition and needs. 
• Partner with the Market Vice President on creating growth strategies for the market.
   

Use your skills to make an impact
 

Required Qualifications

• 5+ years of progressive experience with provider contracting
• 5+ years of Proven leadership experience, including team building
• Proven contract preparation skills, with an in-depth knowledge of Medicare and other reimbursement methodologies
• Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena
• Must live within the South Florida region (Dade, Broward, Palm Beach County)

Preferred Qualifications

• Bachelor's Degree
• Experience with Specialty/Ancillary contracting
• Experience with ACO/Risk Contracting
• Value based contracting experience

Additional Information

This position is considered "remote/work at home", however, you must live within the South Florida region (Dade, Broward, Palm Beach County) to be considered for this opportunity.

Work at Home Information

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

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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,