高级医院合同策略师
Senior Hospital Contracting Strategist
成为我们关怀社区的一员
高级医院合同策略师/高级供应商合同专业人员负责为一家提供健康保险的组织发起、谈判和执行医生、医院和其他供应商的合同及协议。你将向供应商合同总监汇报工作。作为高级医院合同策略师/高级供应商合同专业人员，你将
- 领导医院和医疗系统协议的谈判，包括报销、合同条款、修订、续签和基于价值的协议
- 具有丰富的管理护理经验，具备医院合同、报销方法、财务分析、复杂谈判、供应商关系管理和领导能力方面的显著专长
- 具有医疗保险优势（Medicare Advantage）、医疗补助（Medicaid）和基于价值的合同的经验
- 评估报销方法，包括DRG、PD、病例费率、POC、门诊费用表和其他支付安排
- 与财务、医学经济、法律、网络管理、理赔、配置和运营部门合作，确保合同在财务上可行且在操作上可执行
- 向供应商传达合同条款、支付结构和报销费率
- 分析合同和条款的财务影响
- 在跟踪系统中维护合同和文件
- 协助根据网络构成和需求识别和招聘供应商
运用你的技能产生影响
所需资格条件
- 本科学位
- 5年以上医疗保险医院谈判经验
- 具有领导医院和医疗系统协议谈判的经验，包括报销、合同条款、修订、续签和基于价值的协议
- 5年以上在医疗公司中的逐步网络管理经验，包括医院合同和网络管理
- 具有与医院系统（包括急性后护理、辅助服务供应商和医生）谈判管理护理合同的经验
- 能分析、理解并向供应商传达合同条款、支付结构和报销费率的财务影响
- 理解并解释医院合同条款
- 熟练使用Microsoft Office：Word、Excel和PowerPoint
优先资格条件
- 硕士学位
- 具有ACO/风险合同的经验
- 具有基于价值的合同的经验
附加信息
东部时间上午8点至下午5点，根据业务需要出差
查看英文原文
Become a part of our caring community
The Senior Hospital Contracting Strategist / Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital and other provider contracts and agreements for an organization that provides health insurance. You will report to the Director, Provider Contracting.As the Senior Hospital Contracting Strategist/ Senior Provider Contracting Professional you will
- Lead negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value based agreements
- Extensive managed care experience with demonstrated expertise in hospital contracting, reimbursement methodologies, financial analysis, complex negotiations, provider relationship management, and leadership
- Experience with Medicare Advantage, Medicaid, and value based-contracting
- Evaluate reimbursement methodologies, including DRG, PD, Case Rates, POC, OP fee schedules, and alternative payment arrangements
- Partner with Finance, Medical Economics, Legal, Network Management, Claims, Configuration, and Operations to ensure contracts are financially sound and operationally executable
- Communicate contract terms, payment structures, and reimbursement rates to providers
- Analyze financial impact of contracts and terms
- Maintain contracts and documentation within a tracking system
- Help with identifying and recruiting providers based on network composition and needs
Use your skills to make an impact
Required Qualifications
- Bachelor's degree
- 5 or more years of Hospital negotiation experience in Medicare
- Leading negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value based agreements
- 5 or more years of progressive network management experience including hospital contracting and network administration in a healthcare company
- Experienced in negotiating managed care contracts with Hospital systems inclusive of post acute, ancillary providers and physicians.
- Analyze, understand and communicate financial impact of contract terms, payment structures and reimbursement rates to providers.
- Understand and interpret Hospital contract language
- Proficient in Microsoft Office: Word, Excel and PowerPoint
Preferred Qualifications
- Master's Degree
- Experience with ACO/Risk Contracting
- Experience with Value Based Contracting
Additional Information
8am to 5pm EST, Travel based on business needs
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$78,400 - $107,800 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 10-02-2026
About us
About CarePlus Health Plans: CarePlus Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to help people with Medicare, or both Medicare and Medicaid, achieve their best possible health and wellness through plans with benefits and services they care about. As a wholly owned subsidiary of Humana, CarePlus currently serves Medicare beneficiaries throughout 21 Florida counties.About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
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.
Originally posted on Himalayas