Job type full-time
Benefits pulled from the full job description
Work from home
Full job description
The market development advisor oversees the implementation and operations of the tricare contract in smaller multi-city geographic areasYou will have multiple humana contract offices (hcos) under your supervision and responsibility for multiple plan areasResponsibility for financial performance under the contract, military health system (mhs) optimization efforts and improving contract incentive performanceSupervises tricare community liaisons and overall operation of the hcosResponsible for network management to include network adequacy, access to care standards, provider relations and provider management over multiple prime service areas and transitional prime service areas (tpsas)Responsible for creating and maintaining high performing networks throughout the psas with a focus on improving steerage to the best quality providers while adhering to the government quadruple aim constructEnsure contractual compliance, coordinate and direct the efforts of hco and wah staff to optimize resultsResponsible for maintaining good working relationships and maintaining communication as the primary point of contact with military treatment facilities, commanders and their staffs within assigned psaCoach and develop associates to improve performance and prepare for future positions.
Key accountabilities –
Contribute to humana government business (hgb) profitability through effective psa/tpsa leadership and management primarily through maximization of contract incentives and operational field metrics
Develop and sustain a high performing network in the market using the quadruple aim construct that meets all contract requirementsWhile maintaining provider data quality, support network development and management in cost of care initiatives by developing, implementing and monitoring optimization strategies to ensure maximum network utilization in multiple plan areasDetermine the strengths and weaknesses of the network system and develop options and recommendations for change to better serve military treatment facilities (mtfs) and beneficiariesEvaluate results and coordinate activities with other departments and functional areas within the companyParticipate in success of meeting established goals and objectives of network development and other network activities and reporting requirementsParticipate in the development and implementation of network development and steerage strategiesInteract with network providers to develop and foster relationships and proactively support the needs of the networkIdentify evaluate, and solve problems to ensure timely resolution.
Sustain tricare east region contract excellence
Assist mtfs in all optimization efforts to include maximizing enrollment, efficient rofr processes and development of appropriate csas and ersas
Maintain positive, collaborative relationship with mtf and other government representatives, to include all internal and external customersDirect the operation of multiple assigned hco(s)Ensure compliance with contractual requirements, coordinate and direct the efforts of hco or wah staffContribute to the achievement of “best practices” by participating in development of, and providing feedback on, hco operation plans before implementationEnsure appropriate mtf support through acm and working group participation, issue resolution and completing all required briefings
Develop and coach front line leader(s) and associates to assist them in achieving career objectivesDevelop staff and maintain high market associate engagement scores
Respond and assist in contingency operations in support of the mtf and network as needed
Our department of defense contract requires u.sCitizenship for this position.
This role description in no way states or implies that the key accountabilities above are the only ones being performed by the individual(s) with this role descriptionThe individual(s) may be called upon and required to follow other instructions or perform other duties and tasks requested by his or her supervisor, consistent with the purpose of the position, department and/or company objectives.
Our department of defense contract requires u.sCitizenship for this position
Successfully receive interim approval for government security clearance (eqip – electronic questionnaire for investigation processing)
Bachelor`s degree or equivalent leadership experience
3 plus years of supervisor or leadership experience
Experience coordinating the activities of diverse functions
Excellent written and oral communication skills
Ability to analyze data and make informed recommendations
Proven track record in developing working relationships and influencing throughout the matrix environment
Demonstrated proficiency in plan development, analytics and reporting
Proficient with microsoft office products to include word, excel and outlook
Work at home/remote requirements
Wah requirements: must have the ability to provide a high speed dsl or cable modem for a home officeAssociates or contractors who live and work from home in the state of california will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
Satellite and wireless internet service is not allowed for this role.
A dedicated space lacking ongoing interruptions to protect member ph
Master’s degree with concentration in nursing, healthcare administration or other related field
Managed care experience
Network development experience
Mcg criteria knowledge
Experience in tricare or other federally regulated healthcare programs
Work style: remote (must live within a 1 hour radius of fort knox army base)
Will primarily work remotely but will also travel onsite to fort knox army base in fort knox, ky as needed
Will provide additional oversight to other prime service area (lexington) and non-prime service area beneficiaries and providers throughout the state of kentucky
As part of our hiring process, we will be using an exciting interviewing technology provided by modern hire, a third-party vendorThis 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 interviewIf participating in a pre-recorded interview, you will respond to a set of interview questions via your phoneYou 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 to answer the questions providedExpect this type of interview to last anywhere from 5-10 minutesYour 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.
Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including covid-19 boostersAssociates who remain unvaccinated must either undergo weekly negative covid testing or wear a mask at all times while in a humana facility or working outside of their homes.
Please note: some areas of our business, such as the primary care organization including centerwell, conviva, kindred at home, onehome, seniorbridge, neighborhood centers, pharmacy distribution centers, and others, may be required to adhere to federal, state, or local or additional workplace guidelines.
We continue to encourage all associates to become vaccinated, as vaccines remain the best and most effective defense against covid-19.
Scheduled weekly hours
Posted 5 days ago
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