Senior Hospital Contracting Strategist
CarePlus Health Plans · Tennessee, United States · 1 mo ago
RemoteRemoteOTHR$78k–$108k/yrFull-time
We need to output HTML fragment with sections: h3 headings for sections present: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We must include only sections with real specific content. Let's parse posting.
Content:
- Intro: "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 agreementsExtensive managed care experience with demonstrated expertise in hospital contracting, reimbursement methodologies, financial analysis, complex negotiations, provider relationship management, and leadershipExperience with Medicare Advantage, Medicaid, and value based-contractingEvaluate reimbursement methodologies, including DRG, PD, Case Rates, POC, OP fee schedules, and alternative payment arrangementsPartner with Finance, Medical Economics, Legal, Network Management, Claims, Configuration, and Operations to ensure contracts are financially sound and operationally executableCommunicate contract terms, payment structures, and reimbursement rates to providersAnalyze financial impact of contracts and termsMaintain contracts and documentation within a tracking systemHelp with identifying and recruiting providers based on network composition and needs"
That's basically description of role/responsibilities.
Then "Required Qualifications Use your skills to make an impact Bachelor's degree5 or more years of Hospital negotiation experience in MedicareLeading negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value based agreements5 or more years of progressive network management experience including hospital contracting and network administration in a healthcare companyExperienced 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 languageProficient in Microsoft Office: Word, Excel and PowerPoint"
Then "Preferred Qualifications Master's DegreeExperience with ACO/Risk ContractingExperience with Value Based Contracting"
Then "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 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. $78,400 - $107,800 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 09-11-2026 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 ..."
We need to remove boilerplate: EEO, equal opportunity, application instructions, navigation, cookie, legal, etc. Also remove "Application Deadline: 09-11-2026" maybe considered application instruction? It's a date; but it's not instructions to apply. Might keep? The instruction says remove application instructions. The deadline is not instruction but could be considered metadata; but we can drop it as minor metadata. Also "About Us" sections maybe not needed? They are descriptive but not required? The instruction: preserve ALL substantive information; do not invent or summarize away detail. Remove cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions. "About Us" is not boilerplate; it's substantive about company. Could keep as maybe a section? But we only have allowed headings: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. No "About Us" heading allowed. So we must fold that info into maybe a short paragraph under About the role? Or we could omit because not fitting headings? The instruction: "Prefer a few substantive sections over many thin ones." We can include About the role (intro), Responsibilities (duties), Requirements (maybe required qualifications), Qualifications (preferred?), Skills (maybe Microsoft Office), Benefits, Pay, Schedule. We need to decide.
Let's extract:
About the role: introductory paragraph describing role, reporting line, purpose.
Responsibilities: list of duties: lead negotiations, evaluate reimbursement methodologies, partner with various departments, communicate terms, analyze financial impact, maintain contracts, help identify/recruit providers.
Requirements: maybe required qualifications: Bachelor's degree, 5+ years hospital negotiation experience in Medicare, 5+ years progressive network management experience including hospital contracting, experienced negotiating managed care contracts with hospital systems inclusive of post acute, ancillary providers and physicians, analyze/understand/communicate financial impact, understand/interpret hospital contract language, proficient in MS Office.
Qualifications: preferred: Master's degree, Experience with ACO/Risk Contracting, Experience with Value Based Contracting.
Skills: maybe we could combine required qualifications and skills; but we have separate headings for Skills. Could put MS Office proficiency under Skills.
Benefits: list: medical, dental, vision, 401(k), time off (PTO, company/personal holidays, paid parental/caregiver leave), short-term/long-term disability, life insurance, many other opportunities.
Pay: $78,400 - $107,800 per year, plus bonus incentive plan.
Schedule: 8am to 5pm EST, Scheduled Weekly Hours 40, Travel based on business needs, occasional travel to offices for training/meetings, work at home requirements (internet speed, dedicated space). Also "Work at Home Requirements" details.
We need to output HTML with headings and
headings and - for lists,
for prose.
We must not repeat job title as heading. Not include Job ID.
We must not create sections with filler like "commensurate with experience". We have actual content.
Let's craft.
First, About the role: a paragraph.
Second, Responsibilities: bullet list.
Third, Requirements: bullet list (required qualifications).
Fourth, Qualifications: bullet list (preferred qualifications).
Fifth, Skills: maybe bullet list (MS Office proficiency). Could also include other skills like negotiation, financial analysis, relationship management, but those are in responsibilities/requirements. We'll keep Skills as MS Office.
Sixth, Benefits: bullet list.
Seventh, Pay: paragraph with range and bonus.
Eighth, Schedule: paragraph with hours, travel, work-at-home requirements.
We need to ensure we don't include boilerplate like "Equal Opportunity Employer". Remove.
Also remove "Application Deadline". Remove "About Us" sections.
Let's write.
HTML:
About the role
The Senior Hospital Contracting Strategist / Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital and other provider contracts for a health insurance organization. The role reports to the Director, Provider Contracting and leads negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value‑based arrangements.
Responsibilities
- Lead negotiations for hospital and health system agreements (reimbursement, contract terms, amendments, renewals, value‑based agreements)
- 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 identify and recruit providers based on network composition and needs
Requirements
- Bachelor’s degree
- 5+ years of hospital negotiation experience in Medicare
- 5+ years of progressive network management experience including hospital contracting and network administration in a healthcare company
- Experience negotiating managed care contracts with hospital systems, including post‑acute, ancillary providers and physicians
- Ability to analyze, understand, and communicate financial impact of contract terms, payment structures, and reimbursement rates to providers
- Ability to understand and interpret hospital contract language
- Proficient in Microsoft Office (Word, Excel, PowerPoint)
Qualifications
- Master’s degree (preferred)
- Experience with ACO/Risk Contracting (preferred)
- Experience with Value Based Contracting (preferred)
Skills
- Microsoft Office proficiency (Word, Excel, PowerPoint)
Benefits
- Medical, dental, and vision benefits
- 401(k) retirement savings plan
- Time off (paid time off, company and personal holidays, paid parental and caregiver leave)
- Short‑term and long‑term disability
- Life insurance
- Additional wellness opportunities
Pay
The estimated starting base pay range is $78,400 – $107,800 per year for full‑time (40 hours/week) employment. The position is eligible for a bonus incentive plan based on company and/or individual performance.
Schedule
Standard hours are 8 a.m. to 5 p.m. EST, 40 hours per week. Occ
for prose. We must not repeat job title as heading. Not include Job ID. We must not create sections with filler like "commensurate with experience". We have actual content. Let's craft. First, About the role: a paragraph. Second, Responsibilities: bullet list. Third, Requirements: bullet list (required qualifications). Fourth, Qualifications: bullet list (preferred qualifications). Fifth, Skills: maybe bullet list (MS Office proficiency). Could also include other skills like negotiation, financial analysis, relationship management, but those are in responsibilities/requirements. We'll keep Skills as MS Office. Sixth, Benefits: bullet list. Seventh, Pay: paragraph with range and bonus. Eighth, Schedule: paragraph with hours, travel, work-at-home requirements. We need to ensure we don't include boilerplate like "Equal Opportunity Employer". Remove. Also remove "Application Deadline". Remove "About Us" sections. Let's write. HTML:
About the role
The Senior Hospital Contracting Strategist / Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital and other provider contracts for a health insurance organization. The role reports to the Director, Provider Contracting and leads negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value‑based arrangements.
Responsibilities
- Lead negotiations for hospital and health system agreements (reimbursement, contract terms, amendments, renewals, value‑based agreements)
- 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 identify and recruit providers based on network composition and needs
Requirements
- Bachelor’s degree
- 5+ years of hospital negotiation experience in Medicare
- 5+ years of progressive network management experience including hospital contracting and network administration in a healthcare company
- Experience negotiating managed care contracts with hospital systems, including post‑acute, ancillary providers and physicians
- Ability to analyze, understand, and communicate financial impact of contract terms, payment structures, and reimbursement rates to providers
- Ability to understand and interpret hospital contract language
- Proficient in Microsoft Office (Word, Excel, PowerPoint)
Qualifications
- Master’s degree (preferred)
- Experience with ACO/Risk Contracting (preferred)
- Experience with Value Based Contracting (preferred)
Skills
- Microsoft Office proficiency (Word, Excel, PowerPoint)
Benefits
- Medical, dental, and vision benefits
- 401(k) retirement savings plan
- Time off (paid time off, company and personal holidays, paid parental and caregiver leave)
- Short‑term and long‑term disability
- Life insurance
- Additional wellness opportunities
Pay
The estimated starting base pay range is $78,400 – $107,800 per year for full‑time (40 hours/week) employment. The position is eligible for a bonus incentive plan based on company and/or individual performance.
Schedule
Standard hours are 8 a.m. to 5 p.m. EST, 40 hours per week. Occ