Director Group Provider Strategy - North

Profile

Description

The Director, Group Provider Strategy partners with the assigned Employer Group Market Presidents within the Region on the Employer Group provider strategy, provider performance and health plan contract compliance. The Director, Group Provider Strategy requires an in-depth understanding of how organization capabilities interrelate across the segment and enterprise.

Responsibilities

Contracting expert for aligned Employer Group markets.

Partners with Market Presidents, RVPs, Provider Experience and the centralized provider organizations to improve growth and profitability within the assigned markets.

Lead and advance market strategies that will drive parity improvements, unit cost improvements, deliver medical trend bender savings, and maintain and drive new network innovations to remain contemporary with the industry and competitive in the local markets.

Create and execute on break-through plans in focus markets and disruption plans in non-focus markets.

Create and implement initiatives to increase membership in value-based contracts to improve quality, outcomes and cost-of-care.

Increase member steerage to higher performing providers to support upmarket growth.

Develops and implements programs and large-scale provider initiatives for the aligned markets, such as transparency initiatives, brand- over networks, network adequacy etc.

Works closely with RVPs, Provider Experience and RVP, Group Market Operations to identify target markets where Humana can win in Commercial.

Partners with contracting team to communicate contract terms, payment structures, and reimbursement rates to providers. Ensure the Employer Group's needs are met during negotiations.

Analyzes financial impact of Provider contracts and terms. Ensures that commercial plans are meeting or exceeding corporate Commercial performance benchmarks.

Builds and maintains relationships, and represents the Employer Group priorities with aligned RVPs, Provider Engagement, Retail Market Presidents and centralized provider functions.

Build and maintains relationships with providers and aligned partners within a region. Participates in provider Joint Operating Committees and represents the EG Market President as needed.

Partners with Provider Engagement Executives aligned to key provider and IDSes. Delivers and consult with aligned providers on Group provider performance and quality data.

Required Qualifications

At least 5 years of relevant industry experience with commercial health plans and experience leading or influencing others.

Prior demonstrated success in network management or provider engagement/relations.

Proven experience working with Market Leaders and senior leaders within Humana.

Understanding of corporate strategic goals; Understanding of Humana's clinical model.

Excellent written and verbal communications skills.

Experience in creating, and executing on, an enterprise scale business development strategic plan

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Expert collaborator

Bachelor's degree

Preferred Qualifications

Master's degree

Additional Information

Work location is flexible

#MarketOpModel

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com