Become a part of our caring community
Join Humana in this dynamic role where your expertise will directly influence our provider network and guide organizational success. Reporting to the Provider Contracting Manager within the WI Medicaid Market, you will communicate contract terms, analyze financial impacts, maintain accurate documentation, and recruit providers to meet strategic needs. If you're passionate about making a meaningful difference in healthcare and excel in a collaborative environment, we encourage you to join us and help shape the future of our network.
Key Responsibilities:
- 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.
- Analyze the department's service utilization.
- Responsible for identifying and recruiting providers based on network composition and needs.
- Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas.
Use your skills to make an impact
Required Qualifications
- Bachelor's degree OR in lieu of degree, 2 or more years in negotiating managed care contracts with physicians, hospitals and/or other provider contracts.
- 2 years of experience working with health care and/or long term care providers
- 1 year of experience working in or with health insurance, managed care, or long term care programs
- Reside in Wisconsin or a contiguous state (MN, IA, IL), with the ability to travel up to 15% in WI
- Experience managing multiple projects or tasks at the same time
Preferred Qualifications
- Proficiency in analyzing and communicating financial impact of contract terms, payment structures and reimbursement rates to providers
- Experience with Value Based Contracting
Additional Information
- Workstyle: Home
- Travel: up to 15% within WI
- Typical Work Days/Hours: Monday – Friday, 8:00am – 5:00 pm CST
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 recommended; wireless, wired cable or DSL connection is suggested.
- Satellite, cellular and microwave connection can be used only if approved by leadership.
- Humana will provide Home or Hybrid Home/Office employees 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.
HireVue
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
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.
$65,000 - $88,600 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, volunteer time off, 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.