Director of Network Relations

Job Description: Humana Inc., headquartered in Louisville, Ky., is one of the nation's largest publicly traded health benefits companies, with approximately 9 million medical members. Humana offers a diversified portfolio of health insurance products and related services - through traditional and consumer-choice plans - to employer groups, government-sponsored plans, and individuals.

Over its 45-year history, Humana has consistently seized opportunities to meet changing customer needs. Today, the company is a leader in consumer engagement, providing guidance that leads to lower costs and a better health plan experience throughout its diversified customer portfolio.


Role: Director of Network Relations
Location: Atlanta, GA

Are you a fit?
Do you have the combination of contracting and provider relations experience that will help facilitate Humana's desire to be the provider's payer of choice?

Assignment Capsule
You willl monitor, enhance and drive positive provider relations, facilitating Humana's goal to be providers' payer of choice. You will coordinate the efforts of, and facilitate accountability among, other associates and teams who impact the provider experience.

Facilitate informational seminars/meetings with medical providers, office staff and professional organizations.

Monitor metrics and benchmarks around the provider experience, and engage appropriate associates to turn around negative trends.

Analyze information and identify and implement opportunities to improve relationships with providers.

Develop and maintain key provider profiles, and execute relationship-enhancing activities with key providers.

Work closely with contracting staff and obtain and share information to guide negotiation strategy and facilitate a supply-chain management approach to provider relationship management and network contracting.

Lead cross-functional teams to make certain intent and terms of complex provider contracts are understood and loaded to both parties' expectations.

Serve as liaison between local geography and other key associates/teams, which may include: provider service executive/manager, financial recovery associates, payment system load teams, e-deployment teams, corporate network team, corporate provider communications, compliance, centralized provider relations, Medicare risk adjustment teams, clinical nurse advisors, market medical officers, etc.
Key Competencies

Contracting and Provider Relations: You understand how to concentrate contracting efforts by qualifying and prioritizing new contracting opportunities by focusing on what the Customer values and expects. You plan and execute on network development opportunities. You execute on the brand promise [Guidance When You Need It Most] through value-added provider relations activities which result in improved provider persistency.

Implementation/Execution: You effectively leverage available resources (financial, people, time) to accomplish objectives and maximize return on investment. You make appropriate decisions in the face of ambiguity. You anticipate and resolve barriers and constraints. You organize and manage multiple priorities and/or projects using appropriate methodologies and tools.

Problem Solving: You proactively identify and evaluate problems. You identify appropriate subject matter experts and other information resources to resolve problems. You collect, analyze and draw conclusions from information. You leverage appropriate problem-solving/analysis tools and/or steps. You can differentiate between symptoms and root cause - effectively handles resolution or hand-off of both components.
Role Essentials

Bachelor's degree.

5+ years in health insurance or medical provider administrative setting, with proven ability to enhance relationships with vendors or business partners.

Hospital Contracting experience.

Strong oral and written communication skills

Strong presentation and team facilitation skills

Public relations background or skills.

Strong analytical skills with ability to ascertain information from reports and make appropriate decisions.

Ability to oversee multiple projects and teams, work in a matrix environment, and hold team members accountable for tasks and outcomes.

Ability to view situations from multiple perspectives, analyze those perspectives against objectives

Searchable Keywords: Director of Network Relations / gj-mo

Expected Travel Time: About 50%