Manager Provider Contracting - Florida Medicaid Long-Term Care

Profile

Description

The Manager, Provider Contracting initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Manager, Provider Contracting works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

Responsibilities

The Manager, Provider Contracting communicates contract terms, payment structures, and reimbursement rates to providers. Analyzes financial impact of contracts and terms. Maintains contracts and documentation within a tracking system. May assist with identifying and recruiting providers based on network composition and needs. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.

Required Qualifications


Bachelor's Degree or equivalent experience within Florida Medicaid Long Term Care
2 or more years of Provider Relations and/or Contracting within Florida Medicaid Long Term Care
2 or more years of management experience/or equivalent including managing and delegating team workload, creating workflow processes and team building
Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena
Proven contract preparation skills, with an in-depth knowledge of Medicaid and other reimbursement methodologies
Excellent written and verbal communication skills and experience presenting to varied audiences
Ability to manage multiple priorities in a fast-paced environment
Advanced skills within Microsoft Office applications, including Excel and Power Point
Ability to travel statewide to meet with direct reports and providers
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Must have Project Management experience i.e. delegation of tasks, validation of results, execution.


Preferred Qualifications


Master's Degree
Experience with ACO/Risk Contracting
Value based contracting experience


Additional Information


COVID VACCINATION : Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.
WORK AT HOME Requirements : Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense. A minimum standard speed for optimal performance of 25*10 (25mpbs download x 10mpbs upload) is required. Satellite and Wireless Internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
DRIVE REQUIREMENTS: This job is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits and requires running a Motor Vehicle Report as part of the background check process.


Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ****

Company info

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