Green Bay, WI, United States
Nov 17, 2021
Market Development Advisor (Remote US)
Humana's Medicaid Strategic Partnership team is looking for an experienced Market Development Advisor to join working remote anywhere in the US. 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 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 performance benchmarks. Maintains relationships with regulators within a region.
Key Role Functions
Collaboratively engage with Medicaid market operations in the oversight of assigned third parties
Partner with fellow relationship managers to drive cross-market coordination, identify and translate relationship management best practices, and influence related Humana policy and procedure
Demonstrate third party monitoring and oversight practices consistent with expectations set forth in Humana policies and procedures and as required by the respective Medicaid plans, inclusive of the following:
Establish and manage Performance Standard (aka Service Level Agreements or Key Performance Indicators)
Collaboratively resolve challenges and drive operational Improvement
Verify all reporting requirements are met
Host Joint Operating Committee (JOC) Meetings with assigned third parties
Support compliance oversight by:
Participating in relevant audits
Facilitating effective and timely response to, and resolution of, compliance considerations, including Corrective Action Plans, material audit findings, requests for information, etc.
Escalating performance issues
Partnering with the assigned third parties and key Humana stakeholders to maximize Florida Subcontractor value
Effectively manage contract-related matters, inclusive of the following:
Coordinate with all key constituents, including those within finance, market operations, corporate Medicaid, clinical, quality, and compliance, to negotiate best terms and assess the impact of provisions
Oversee contract monitoring, renewals, and content of contracts with assigned third parties for the Medicaid program
Contribute to Medicaid business development initiatives associated with requests for proposal, invitations to negotiate, requests for information, and other similar effort by providing details of contracted relationships, functional responsibilities, and other relevant content to support Medicaid growth
5 years demonstrated proficiency in the engagement and management of third parties, inclusive of performance oversight, compliance coordination, and contract management
2 years operations, strategy, or related business unit experience
Demonstrated strength in direct and facilitation leadership experience, including extensive history managing and influencing outcomes in a matrixed environment
Strong verbal and written communication skills; able to interact effectively with people at all levels within a team or internal division
Demonstrated accuracy and thoroughness in past work; fosters quality in others
Track record for identifying and driving process improvements
A strong critical thinker with exceptional problem solving skills; detailed and well organized
Accepts responsibility, is self-motivated and accountable for aligned business goals and objectives
Must be able to travel up to 20% depending on business needs
Master's degree in Business, Marketing, Finance/Accounting, or Health Administration
Past experience working in, or supporting, Medicaid operations
Covid-19 Vaccine/Testing Requirement
For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
If progressed to offer, you will be required to:
Provide proof of full vaccination OR
Commit to weekly testing, following all CDC protocols, OR
Provide documentation for a medical or religious exemption consideration.
This policy will not supersede state or local laws. Requests for these exemptions should be submitted at least 2 weeks prior to your scheduled first day of work.
Work at Home/Remote Requirements
Must ensure designated work area is free from distractions during work hours and virtual meetings
Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required
Based on current guidance from the CDC, local and state governments, and Humana leadership related to the coronavirus (COVID-19) outbreak have extended travel restrictions until further notice. The policy will be reassessed as the situation warrants. Once these restrictions are lifted this role may require up to 20% travel depending on business needs.
Scheduled Weekly Hours