Market Development Advisor

Sacramento, CA, United States

Become a part of our caring community and help us put health first

The Market Development Advisor provides support to assigned health plan and/or specialty companies relative to Medicare/Medicaid/TRICARE/Employer Group product implementation, operations, contract compliance, and federal contract application submissions. The Market Development Advisor - Practice Transformation provides support to assigned health plan and/or specialty companies relative to Medicaid Group product implementation, operations, contract compliance, and federal contract application submissions. The Market Development Advisor works on problems of diverse scope and complexity ranging from moderate to substantial.

The Market Development Advisor-Practice Transformation is responsible for driving provider performance programs, goals and improvement metrics for network providers to include a focus on Behavioral Health providers and partnerships. The Practice Transformation Advisor is an integral part of a cross-functional, collaborative organization which includes Provider Service Experience, Network Optimization, Clinical Services, Value-Based contracting, HEDIS and Risk Adjustment. Reporting to the Director, Provider Experience and Practice Transformation, this individual ensures the effective management of provider performance and quality improvement programs for Humana Healthy Horizons in Ohio.

The Market Development Advisor serves as the primary resource on regulations for all assigned health plans. Ensures that assigned health plans are meeting or exceeding corporate Medicare/Medicaid/TRICARE/Employer Group performance benchmarks. Maintains relationships with regulators within a region. Advises executives to develop functional strategies (often segment specific) on matters of significance. 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.

Responsibilities

Leading and managing the Provider Performance team for Ohio Medicaid and engaging with providers and internal stakeholders to drive high performance in quality and cost efficiency.

Designing and implementing programs to maintain positive relationships between the health plan, physician, providers and practice managers.

In conjunction with the Director of Behavioral Health, and the Director of Provider Engagement and Practice Transformation, responsible for strategy implementation for Behavioral Health providers and associations.

Supporting Stars, HEDIS & Risk Adjustment initiatives and Ohio Department of Health quality initiatives for PRAF, Diabetes and other targeted campaigns.

Monitor all feedback from individual providers to inform improvements to Humana processes.

Develop provider training/orientation materials and timely communications of changes to the Ohio Department of Medicaid program.

Acting as provider performance knowledge leader, lead external and internal training for providers and associates related to Ohio Department of Health value-based programs to include Episodes of Care, Comprehensive Maternal Care, CICIP and other initiatives.

Monitor provider's performance against key performance indicators and contractual commitments and requirements. Work with health plan leadership to improve performance, develop and implement quality improvement initiatives.

Supporting in the onboarding and training of new provider engagement and provider transformation team members on performance programs and initiatives.

Collaborates with internal stakeholders on development and implementation of value-based programs and alternative payment models.

Acts as a supporting function of the broader Provider Experience team.

Use your skills to make an impact

Required Qualifications

Bachelor's degree or 5 years of Market Development Advisor experience.

5+ years of experience with Medicaid/Medicare/Duals Employer Group operations

3 or more years of progressive experience in managed care operations including practice performance, provider engagement, value-based program implementation

Travel required as needed

Success in developing working relationships within a highly matrixed business environment

Ability to analyze data and make informed recommendations

Ability to lead a team of associate and collaborate with cross functional teams

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

Master's degree

Experience responding to state and/or federal government solicitations

Experience developing relationships with key stakeholders to understand and improve the market

Additional Information

Alert:

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from [email protected] with instructions on how to add the information into your official application on Humana's secure website.

Interview Format: HireVue

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

WAH Home Statement:

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

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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.$93,000 - $128,000 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

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 because he or she is a protected veteran. 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.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.