Provider Contracting Executive

Location: Remote Georgia

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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

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.

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements.

This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Additional Locations: Work at Home - South Carolina, Work at Home - North Carolina, Remote Florida - Jacksonville