Humana AVP, Health Plan Relationships and Contracting in Billings, Montana
Help grow one of the leading value-based, senior-care providers in the countryPartners in Primary Care and Family Physicians Group (collectively the Care Delivery Organization) are one of the largest and fastest-growing value-based, senior-focused primary care platforms in the country. Operating as a payer-agnostic, wholly owned subsidiary of Humana, Inc., the Care Delivery Organization has more than doubled its footprint in the last two years. Following the creation of a $600M joint venture with Welsh, Carson, Anderson, and Stowe, a leading health care private equity firm, in February 2020, the Care Delivery Organization is on-pace to double again in the next few years.To support that growth, the Care Delivery Organization (CDO) is building out its contracting function. That team is charged with accelerating the Organization’s organic growth through execution of a comprehensive contracting strategy.Against that backdrop, the CDO is seeking an experienced healthcare contracting executive for the newly-created position of Associate Vice President, Health Plan Relationships and Contracting, which will oversee the CDO’s health plan and other contracted relationships nationally and locally. This role is crucial in ensuring the CDO achieves its goals by securing access to prospective patients and collaboration with payers and other providers to improve quality and cost. With the CDO’s rapid expansion, contracting activities continue to grow substantially in volume, financial impact, and complexity. Existing contracts must be continually renegotiated and aggressively managed. This role will manage medical cost through contracting initiatives and analysis of financial reports and trends in the marketplace. Contractual arrangements will be complex and comprehensive, needing a depth of understanding of managed care, primary care and MSO services. This position reports to the VP, Chief Growth Officer, Care Delivery Organization.Our preferred location for this position is at our corporate headquarters in in Louisville, KY. However, other locations will be considered on a case-by-case basis for strong candidates.
Health plan relationship development and management: Introducing the CDO to local and national leaders of health plans, finding win-win collaboration opportunities and ensuring operationalization of key growth, quality and efficiency strategies. This includes presenting CDO’s unique value proposition to external key audiences.
Value-based contracting: Representing the CDO’s value proposition to key local and national health plan contracting decision makers, negotiating value-based contracts aligned with the CDO’s preferred format, and innovating collaboration with payers to sustain the CDO’s competitive advantage in the marketplace. This could include contracting affiliate primary care physician providers as well as contracting with downstream specialty providers.
Contract Management: Direct leadership and supervision of a team that manages administration of contracts, physician roster management, CDO presence in payer directories, claims payment issues, etc. Enhance the systems and processes necessary for optimal contract management. Partner with CDO Population Health and Finance teams to ensure timely and accurate payments and key data sharing.
Partnering with CDO Markets: Develop joint strategic plan to support market growth with local CDO market leadership teams, including developing priorities, coordinating on initiatives and ensuring execution.
Fostering Collaboration with External Stakeholders: Establish collaborative forums with local and national health plan leadership teams and key providers to advance shared objectives, includes establishing agendas, developing presentations and analyses and ensuring execution.
Team: Develop and direct supervision and management of a newly-established team of distributed and local health plan relationship management and contract management professionals. Includes continued development and dissemination of systems, processes and best practices for local market strategy and management. Also includes ensuring professional development of the team.
Key Deliverables (12-18 month horizon):
Select and implement a contract management system
Define the standard operating model for the team
Achieving scalability of back office functions
Key Candidate Qualifications:
The successful candidate will have extensive experience (ideally 7+ years) in health care administration, specifically in the payer and/or provider contracting field. He/she will also have a demonstrable network of broad, deep, and relevant relationships with health plan leaders and/or track-record of developing such relationships. Proven ability to negotiate risk-based and capitated contracts with health plans and affiliate or downstream contracts with providers is critical for success in this position.
In addition to the above, the following professional qualifications and personal attributes are also sought:
Strong collaboration skills with broad group of internal and external stakeholders and business partners, including building and executing strategic plans in partnership with CDO Market Presidents and other CDO business partners
Deep understanding of Medicare reimbursement, Medicare Advantage health plan economics, and value-based and capitation contracting models, including legal and regulatory considerations
Demonstrated success negotiating value based contracts with various health plans using a diverse range of techniques and contracting ''best practices'' to include capitation, quality reward programs, and path-to-risk arrangements
Demonstrated success and creativity of collaborating with health plans to grow value-based provider practices
Technical understanding of contracting “back-office” functions, both with health plans and within provider operations
A proven record of success in building, developing, and leading a high-performing team of contracting professionals; elevating the overall caliber of the team; and elevating and expanding the capabilities of the team to new levels of maturity and sophistication.
Excellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with senior and executive level audiences
Strong process design and execution orientation
Supervise and execute special projects as assigned.
Bachelor’s degree in a relevant field (i.e., business administration, finance, health care, etc.) is required; Master’s degree strongly preferred
The Professional Development Opportunity
This role is a great opportunity for anyone with deep healthcare contracting experience to further their career. For those who want to get closer to one of the fastest-growing and most dynamic sectors of health care in America, this role offers the opportunity to develop deep sector and business expertise, working with some of the leading practitioners in the country. This role is also designed to develop future leaders of the Care Delivery Organization, and offers the training, mentorship and exposure to transition into other parts of the business over time, whether other functions or operational roles, locally and nationally.
More about the Care Delivery Organization At PiPC and FPG, we’re seeking innovative people who want to make positive changes in their lives, the lives of our members, and the healthcare industry as a whole. As a senior-focused healthcare provider, and subsidiary of one the nation’s leading integrated health companies, Humana, we put the needs of seniors at the forefront of everything we do. Our multidisciplinary team goes above and beyond to make our nearly 50 centers a leading health and wellness destination for communities in key Medicare markets. PiPC’s national primary care centers serve more than 30,000 Medicare Advantage patients in markets including Kansas City, North Carolina, South Carolina, Orlando and Houston. We are expanding in Houston, South Texas, Louisiana, and Nevada in 2020.
Mission: We make seniors healthier and happier every day.
Vision: To be the leader in personalized primary care for seniors.
Values: C.A.R.E. – Compassion, Accountability, Respect, and Excellence.
Scheduled Weekly Hours
Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.
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