Payer Strategy & Contracting Principal

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The Provider Contracting Principal is responsible for developing and executing on the payer strategy, leading contract negotiations, managing payer relationships, and driving operational implementation and financial performance for an assigned market/payer portfolio.

This role connects enterprise priorities related to payer mix, growth, network access, reimbursement, and economic sustainability with regional and market leadership and key cross-functional partners, including Sales, Operations, Finance, Revenue Cycle, Clinical, Legal, and Compliance. The Principal ensures payer agreements are strategically aligned, financially viable, operationally executable, and well-positioned to deliver measurable value.

The Principal independently leads assigned payer initiatives and negotiations within delegated authority and established governance and approval processes and serves as a key business partner to market and enterprise leadership.

The Payer Strategy and Contracting team leads the development, negotiation, implementation, and ongoing management of profitable national, regional, state and local payer relationships across episodic, fee-for-service, and value-based reimbursement models.

In partnership with Business Development and other enterprise stakeholders, the team evaluates and supports preferred provider and contracted business opportunities across the acute and post-acute continuum, including Medicare Advantage, Commercial, and other value-based payment models.

The Provider Contracting Principal translates enterprise payer strategy into market-level execution. The role evaluates payer opportunities, develops contracting strategies, negotiates agreements, leads cross-functional implementation, manages payer relationships, monitors contract performance, and identifies opportunities to improve reimbursement, access, volume, and financial outcomes.

Payer Strategy & Planning

• Develop and execute payer-specific and market-specific action plans aligned with enterprise payer strategy, growth priorities, and operational capacity.
• Evaluate payer opportunities using referral trends, membership and enrollment data, reimbursement, financial performance, market dynamics, operational capacity, and strategic fit.
• Analyze current payer and market performance to identify growth opportunities, network gaps, underperforming agreements, renewal priorities, reimbursement opportunities, and potential termination risks.
• Develop recommendations regarding payer participation, contracting priorities, reimbursement strategies, and preferred provider opportunities.
• Partner with operational, sales, clinical, and market leadership to establish strategic objectives before negotiations and operational implementation.

Contracting & Negotiation

• Lead the development, negotiation, renewal, and amendment of assigned national, regional, state and local payer agreements within delegated authority and established governance requirements.
• Evaluate reimbursement methodologies and contract terms to determine appropriate financial and operational structures.
• Partner with Finance and Operations to develop financial analyses, business cases, rate recommendations, and contract feasibility assessments.
• Negotiate reimbursement, operational, administrative, and other material contract provisions in collaboration with Legal, Compliance, Finance, Revenue Cycle, Clinical, and operational stakeholders.
• Coordinate stakeholder review, leadership approvals, agreement execution, renewal planning, and key contractual milestones.
• Present contracting strategies, recommendations, risks, and business cases to leadership and governance forums as appropriate.

Operational Implementation & Execution

• Translate contractual requirements into clear operational expectations for referral intake, authorizations, clinical operations, billing, reimbursement, and revenue cycle.
• Lead cross-functional implementation of new and amended payer agreements, establishing accountable owners, deliverables, milestones, dependencies, and escalation pathways.
• Partner with operational and functional leaders to develop workflows, communications, reporting, and other processes required for successful implementation.
• Identify and coordinate resolution of payer-related issues involving referrals, authorizations, eligibility, denials, payment, reimbursement, or other contract requirements.
• Lead or support time-sensitive payer initiatives and escalations that may materially affect patient access, revenue, reimbursement, or market performance.

Payer Relationship Management

• Serve as a primary business and contracting contact for assigned payer relationships.
• Develop and maintain productive relationships across payer contracting, network management, clinical, operations, and other relevant functions.
• Establish and facilitate recurring payer business reviews focused on contract performance, operational issues, growth opportunities, quality, and strategic priorities.
• Coordinate escalation and resolution of material payer issues.
• Identify opportunities to expand network access, referral volume, preferred provider relationships, care coordination, quality initiatives, and value-based arrangements.

Financial Performance & Analytics

• Monitor payer and contract performance against negotiated terms, reimbursement assumptions, volume expectations, and applicable financial measures.
• Evaluate actual reimbursement against contractual expectations and identify reimbursement leakage, unfavorable trends, and operational drivers of performance.
• Partner with Finance, Revenue Cycle, Operations, and other stakeholders to determine root causes and develop corrective action plans.
• Assess the financial impact of proposed reimbursement changes and alternative payment methodologies.
• Provide leadership with clear reporting and recommendations regarding contract performance, financial risks, growth opportunities, renewals, and corrective actions.

Governance & Cross-Functional Leadership

• Lead cross-functional collaboration across Operations, Sales, Finance, Revenue Cycle, Clinical, Legal, Compliance, Business Development, and other stakeholders throughout the contract lifecycle.
• Ensure appropriate market, operational, financial, and functional input is obtained and documented before contract approval.
• Prepare concise business cases, recommendations, and decision materials for established contracting and payer governance forums.
• Maintain appropriate contract documentation, decision records, action logs, implementation plans, and renewal milestones.
• Proactively identify and escalate material financial, operational, contractual, compliance, or implementation risks.
• Serve as a subject matter resource to leadership and internal stakeholders regarding assigned payer relationships and contracting strategies.

Use your skills to make an impact

Required Qualifications

• Bachelor’s degree in Business, Healthcare Administration, Finance, or a related field, or equivalent relevant professional experience.
• Five or more years of experience in managed care, payer contracting, provider relations, payer account management, healthcare finance, business development, or healthcare operations.
• Demonstrated experience interpreting payer agreements and reimbursement structures and leading contract negotiations.
• Strong financial acumen and demonstrated ability to evaluate reimbursement methodologies, contract economics, and business cases.
• Strong analytical, negotiation, problem-solving, stakeholder management, and executive communication skills.

Preferred Qualifications

• Experience in home health, post-acute care, and/or managed care.
• Knowledge of episodic, fee-for-service, and value-based reimbursement payment models, authorization requirements, and revenue cycle processes.
• Experience leading complex initiatives requiring coordination across multiple functional and operational stakeholders.
• Ability to manage multiple payer priorities, deadlines, negotiations, and implementation activities with a high degree of independence.
• Experience with contract performance reporting, reimbursement analysis, and payer-provider issue resolution.
• Experience presenting contracting strategies, business cases, and recommendations to senior leadership.
  

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.$138,900 - $191,000 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: 11-18-2026

About us

About CenterWell Home Health: CenterWell Home Health 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 CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer at CenterWell.com.

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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.