VP, National Provider Network Management

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

Humana is a $100+ billion (Fortune 38) market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong well-being. As a company focused on the health and well-being of the people we serve, Humana is committed to advancing 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.

Against that backdrop, Humana is seeking an accomplished healthcare leader for the position of Vice President, National Provider Network Management. At a high level, this highly visible role will be responsible for defining the strategy for how we negotiate contracts with provider organizations. This position will foster the development of national strategic provider relationships and networks that help advance Humana’s strategy and goals toward improving the health of the communities we serve. The Vice President will also provide executive leadership to the National Contracting, Ancillary Contracting, Behavioral Health Contracting and Provider Analytics teams in support of Humana’s Insurance Business.

This position reports to the Senior Vice President, Provider Experience and will lead an organization of 300+ associates with seven direct reports. Candidates may be located anywhere within the contiguous lower 48 states. Relocation will not be required.

               

Key Responsibilities

• Strategic Partner with all segments of Humana’s Insurance Business, accountable for developing and maintaining strategic network relationships with large national providers.  Ensure adequate coverage of primary care, specialty and ancillary services for Humana to meet both regulatory and sales support need. 
• Align strategy and priority between different segments/functions and be the defined point of contact for escalated provider engagements and issues.
• Establish enterprise wide contracting standards, best practices and policies.  Collaborate across departments and market teams to implement those practices.
• Lead Enterprise change efforts regarding contract standardization, creating simplified processes and policies for our contractors and providers.  Ensure access to care for members, network adequacy and gap closure.
• Develop and lead trend initiatives with key providers and partners. 
• Executive leadership of Provider Performance and Analytics functions, supporting Humana’s value-based contracts and trend bender initiatives.
• Maintain commercial parity pricing with national providers in key commercial markets.
• Manage across a highly matrixed organization aligning priorities and results at a national and regional level. 
• Provide leadership to a team of executives and their staff, driving associate engagement initiatives, developing and managing talent, and leading change efforts.

Use your skills to make an impact
 

Key Candidate Qualifications:

The ideal candidate will have extensive experience contracting and/or managing relationships with Integrated Delivery Systems.  This person will also have extensive business leadership experience, with several years in a managed care environment leading a network development/provider relations function, including proven experience leading contracting for Medicare products.  He/she will possess comprehensive knowledge of health plan finance and the compensation arrangements between health plans and providers, including plan funding, risk management and provider reimbursement.  The successful candidate will also hold a Bachelor’s degree in Finance, Health Care Administration or related field (MBA and/or JD degree preferred).

In addition, the following professional qualifications and personal attributes are sought:

• Experience analyzing the financial viability of complex provider contracts to include subcontracting entities, risk delegation, and other non-standard requirements associated with regulatory and legal contracts.
• Experience leading the “end-to-end” contract negotiation process through closure for different types of providers (hospitals, physicians, sub-acute care facilities) pharmacy networks and delegated specialty services across all health insurance product lines.
• The ability to identify health service expenses and implement cost control mechanisms within contracts.
• Experience identifying and recruiting providers to ensure network alignment with planned sales process execution, orienting providers and managing relationships, and driving improvement in provider satisfaction via education, communication and streamlining claims resolution.
• Prior executive leadership experience in sales, finance, legal, health services, and/or medical management; demonstrated ability to partner across functions to create and deploy win/win strategies.
• Skill in driving results, thinking strategically and executing strategy effectively; thinking at an enterprise level.
• Executive leadership experience, setting vision and goals, aligning talent, developing teams, leading positively and leading through change
• Knowledge of risk arrangements and ability to influence these arrangements
• Recognition as a thought leader in the area of healthcare trend mitigation.  
• Ability to effectively navigate and manage through a matrixed organizational environment in a large (Fortune 250) company.
• Record of success leading the delivery of large, enterprise-scale initiatives involving multiple functions and business segments
• Strong relationship management skills, to teach, tailor, and take control of opportunity definition and initiation with business partners
• Excellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with senior and executive level audiences and positive representation of Humana in external forums.
• Highly collaborative mindset, with excellent relationship-building and negotiating skills, including the ability to engage many diverse stakeholders and SMEs and win their co-ownership in the outcome
• Proven track record in team development and preparing direct reports for expanded responsibilities.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Application Deadline: 05-30-2025

About us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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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.