Become a part of our caring community and help us put health first
 The Virtual Health Network Advisor will be accountable for leading the contracting strategy to support the implementation of Humana Healthy Horizon’s (Medicaid) virtual care provider partnerships designed to enhance member access to care. The contracting strategy within the scope of this role include, but are not limited to, payment model design, key performance indicator development, contract language development, negotiation, contract execution, and management. The Advisor must have strong analytical and critical thinking skills.

The Virtual Health Network Advisor position requires an in-depth understanding of how organizational capabilities interrelate within the enterprise to develop and execute on network strategy. The Advisor exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, uses independent judgment requiring analysis of variable factors and determining the best course of action.

The Virtual Health Network Advisor Key Responsibilities include:

Oversees portfolio of available virtual care providers that Medicaid markets can deploy to increase access to care for Humana Healthy Horizons members.Assists in vetting of potential new virtual care provider partners and solutions for operational and financial feasibility.Drives contracting strategy with new and existing virtual care provider partners, including but not limited to payment model development with Finance and Value-Based teams, ensuring operational feasibility, and key performance indicator and/or service level agreement development.Coordinates with Legal and National Templates teams to develop contract templates and language edits to support negotiations.  Leads contract negotiations with targeted virtual care providers. ​Assists with contract implementation, including participating in operational workgroups, triaging issue resolution to ensure the provider partnership launches on time and creating connections with local market provider relations.Identifies and addresses contractual gaps and potential liabilities in virtual care agreements in partnership with legal and operational partners.Participates in cross-market/national joint operating committees with provider partners to ensure compliance with KPIs and/or SLAs.Coordinates contract expansion of existing virtual care providers to additional Medicaid markets, including contracting strategy and market rollout timelines.Assists new Humana Medicaid markets to understand available virtual care solutions that can be deployed in their market and develop readiness review materials related to virtual care.Stays abreast of industry trends in virtual care coverage and reimbursement in Medicaid states to inform future strategic solutions/contracting efforts.Contributes to virtual care strategy in Medicaid RFP responses.
Use your skills to make an impact
 

Required Qualifications

Bachelor's degree.5+ years of experience in network development, contracting, and/or network operations experience.2+ years of project leadership experience.2+ years of Medicaid experience.Experienced contract negotiator with a proven record of negotiating and implementing virtual care provider agreements.Proficiency in contract language development and redline review.Deep knowledge of contract administration, procedures, and practices.Excellent interpersonal, organizational, written, oral communication, and presentation skills.

Preferred Qualifications

Master’s degree in business administration, healthcare administration, public administration, public health, or public policy.

Work From Home

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 recommended; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Additional Information:

Workstyle: Remote – work at home.Location/Travel: Contiguous United States, up to 10% travel is expected for this role.Core Workdays & Hours: Typically, Monday – Friday 8:00am – 5:00pm Eastern Standard Time (EST).Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more.....  

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor.  This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.  If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Pay 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.

 

$115,200 - $158,400 per year

 

This 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 04-29-2025
About us
 Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.