Market VP, Provider Contracting

3 weeks ago


Hartford, United States USA Jobs Full time

Associate Vice President Of Home Health Provider ContractingThe associate vice president of home health provider contracting will lead a focused team responsible for negotiating and managing reimbursement agreements with managed care organizations and health plans across commercial, medicare advantage, medicaid, and other payer lines of business. This leader will set payment targets, define payer strategy, and operationalize core contracting principles and metrics for the home health business-progressing beyond fee-for-service toward value-based care and innovative payment models (e.g., shared savings, episodic models, capitation, pay-for-performance). The role requires deep experience in payer or managed care contracting and the ability to translate contract terms into financial, clinical, and operational performance. Home health or post-acute experience is preferred but not required.Key responsibilitiesOversee payer negotiations end-to-end for home health services: develop strategy, serve as chief negotiator, and secure favorable rates and terms across commercial, medicare advantage, and medicaid contracts, including fee-for-service, episodic, and value-based agreements.Set annual payment targets and portfolio strategy: define price/volume goals, prioritize payer opportunities, and construct multi-year contracting roadmaps to grow margin and access.Own contract economics and analytics: oversee financial modeling, valuation, scenario analyses, and pro formas to inform deal strategy and renewals.Advance value-based contracting: design and implement models such as shared savings, bundled/episodic payments, pay-for-performance, and new service models aligned to home-based care.Build payer relationships and multi-payer alignment: establish executive-level relationships with plan counterparts; align on quality measures, reporting, and health equity standards to reduce administrative burden and improve outcomes.Translate contracts into operations: partner with revenue cycle, finance, clinical, and operations to implement terms (authorization, billing rules, payment integrity), monitor payer performance, and resolve disputes.Work closely with compliance and legal: manage the papering, review, and signature process for all payer agreements; ensure timely execution, adherence to regulatory requirements, and proper documentation of amendments and renewals.Develop internal contracting discipline: ensure timely document execution, renewals, amendments, and partner with credentialing as applicable.Oversee payer performance metrics: track payer scorecards (rates, denials, underpayments, turnaround times), vbc metrics (readmissions, utilization, home health quality measures), and overall portfolio results.Mentor and develop the team: coach contracting and managed care team members in negotiation tactics, modeling, compliance, and payer relationship management; foster a culture of transparency and results.Ensure compliance and risk management: coordinate with legal on contract language, regulatory updates, and accreditation requirements; monitor adherence to cms and payer policies.Company overviewCenterwell, a human company, creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, centerwell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of humana inc. (nyse: hum), centerwell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.The home solutions business segment is comprised of two major brands - centerwell home health (cwhh) and onehome (oh) with ~11,000 associates dispersed across more than 350 locations nationwide.About centerwell home health: cwhh specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.About onehome: oh coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients' homes. Onehome's patient focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health plans serving more than one million health plan members nationwide. Oh was acquired by humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and above all, caring. It is important to us that our employees are engaged, supported and fairly treated. We offer a comprehensive benefits package to ensure the health and financial well-being of you and your familyUse your skills to make an impactKey candidate qualificationsRequired: 7+ years in payer or managed care contracting on the provider or plan side, including direct negotiation of reimbursement rates and contract terms; leadership experience managing a contracting team.Preferred: Experience in a multi-market or matrixed organization in home health, post-acute, or similar home-based services.Demonstrated expertise in value-based care, with hands-on design/implementation of alternative payment models (shared savings, bundles, pay-for-quality, capitation/pmpm), and familiarity with cms value-based programs.Strong financial acumen: advanced proficiency in contract valuation, pricing analytics, and risk modeling; ability to translate clinical performance to economics and operational impacts.Relationship and influence skills: proven ability to build executive-level partnerships with health plans and internal leaders (finance, clinical, ops, revenue cycle) to achieve contracting goals.Ability to translate contract performance into actionable insights for leadership.Education: bachelor's degree required (health administration, business, finance, or related); master's preferred (mba/mha).Travel: while this is a remote position, occasional travel to humana's offices for training or meetings may be required.Scheduled weekly hours40Pay rangeThe 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.$184,800 - $254,100 per yearDescription of benefitsHumana, 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application deadline: 03-26-2026



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