FREE ACCESS
5,000–10,000 jobs/day
See all jobs on Scoutfield
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in provider network management and healthcare operations, with a strong focus on strategic initiatives, risk mitigation, and cross-functional collaboration. Proven ability to leverage data analytics for decision-making and enhance provider and member experiences in a complex healthcare environment.
Highest-signal resume keywords
Provider Network ManagementHealthcare OperationsData Analytics for Business DecisionsProject LeadershipCross-Functional Initiative Leadership
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Provider Contracting StrategyHealthcare Delivery SystemsPayer-Provider RelationshipsRegulatory NavigationPerformance Monitoring
Soft Skills
Effective Communication with Senior LeadersInfluencing Leaders in a Matrixed Environment
Industry Keywords
Medicare AdvantageMedicaidOperational Friction ReductionMember RetentionNetwork Adequacy
About the role
Key responsibilities & impact- Lead Humana's enterprise strategy for provider network transition and disruption management initiatives
- Assess member, provider, operational, regulatory, and business impacts of provider network changes
- Serve as enterprise lead for provider termination and provider network transition programs
- Partner with Provider Contracting, Market Leadership, Member Retention, Stars, Provider and Member Service, Compliance, Provider Network Operations, and other stakeholders
- Develop and implement mitigation strategies
- Identify emerging provider network risks and opportunities and recommend actions to senior leadership
- Improve provider and member experiences while reducing operational friction and execution risk
- Facilitate executive governance and decision-making for provider network transitions and enterprise risk mitigation
- Develop reporting, analytics, executive communications, and performance monitoring for significant provider network events
- Evaluate impacts on member retention, access to care, network adequacy, Stars performance, service operations, and overall business performance
- Lead cross-functional process simplification and coordination efforts
- Influence leaders across a matrixed organization to drive accountability and remove barriers without direct operational ownership
- Advise senior leaders and executives on strategic initiatives, organizational risks, and opportunities
- Identify and prioritize opportunities to strengthen Humana's provider network transition capabilities
Requirements
What you’ll need- 7+ years of experience in provider contracting, provider network management, healthcare operations, healthcare consulting, or related healthcare strategy roles
- 3+ years of project, program, or people leadership experience
- Strong understanding of provider network operations, provider contracting strategy, healthcare delivery systems, and payer-provider relationships in a Medicare Advantage and/or Medicaid environment
- Experience leading large-scale, cross-functional initiatives across multiple business areas
- Experience influencing leaders and driving results in a matrixed environment without direct authority over execution teams
- Experience using data and analytics for business decisions and executive-level recommendations
- Proven ability to communicate effectively with senior leaders and executive stakeholders
- Ability and willingness to travel up to 10%
- Must reside within the Central or Eastern Time Zone
- Preferred: Bachelor's degree
- Experience navigating complex regulatory, operational, and member experience considerations within a health plan environment
- Minimum home internet speed of 25 Mbps download and 10 Mbps upload
- Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information
Benefits
Comp & perks- Bonus incentive plan based on company and/or individual performance
- Medical benefits
- Dental benefits
- Vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company holidays
- Personal holidays
- Paid parental leave
- Paid caregiver leave
- Short-term disability
- Long-term disability
- Life insurance
- Remote/work-at-home arrangement
- Internet service requirements and dedicated workspace support for home working
- Training and meeting travel support as applicable