Humana Internships – Market Advisor

Job Description:

The Market Development Advisor oversees the implementation and operations of the TRICARE contract in smaller multi-city geographic areas. You will have multiple Humana Contract Offices (HCOs) under your supervision and responsibility for multiple plan areas. Responsibility for financial performance under the contract, Military Health System (MHS) optimization efforts and improving contract incentive performance. Supervises Tricare Community Liaisons and overall operation of the HCOs. Responsible 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 construct.

Job Responsibilities:

• 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
• Develop and coach front line leader(s) and associates to assist them in achieving career objectives. Develop staff and maintain high Market associate engagement scores
• Maintain positive, collaborative relationship with MTF and other Government Representatives, to include all internal and external customers. Direct the operation of multiple assigned HCO(s). Ensure compliance with contractual requirements, coordinate and direct the efforts of HCO or WAH staff. Contribute to the achievement of “best practices” by participating in development of, and providing feedback on, HCO operation plans before implementation. Ensure appropriate MTF support through ACM and Working Group participation, issue resolution and completing all required briefings
• Respond and assist in contingency operations in support of the MTF and network as needed
• Develop and sustain a high performing network in the Market using the Quadruple Aim construct that meets all contract requirements. While 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 areas. Determine the strengths and weaknesses of the network system and develop options and recommendations for change to better serve Military Treatment Facilities (MTFs) and beneficiaries. Evaluate results and coordinate activities with other departments and functional areas within the company. Participate in success of meeting established goals and objectives of Network Development and other network activities and reporting requirements. Participate in the development and implementation of network development and steerage strategies. Interact with Network Providers to develop and foster relationships and proactively support the needs of the network. Identify evaluate, and solve problems to ensure timely resolution
• Contribute to Humana Government Business (HGB) profitability through effective PSA/TPSA leadership and management primarily through maximization of contract incentives and operational field metrics

Job Requirements:

• Proven track record in developing working relationships and influencing throughout the matrix environment
• Our Department of Defense Contract requires U.S. citizenship for this position
• MCG Criteria knowledge
• Ability to analyze data and make informed recommendations
• Proficient with Microsoft office products to include Word, Excel and Outlook
• Excellent written and oral communication skills
• Successfully receive interim approval for government security clearance (eQIP – Electronic Questionnaire for Investigation Processing)
• Demonstrated proficiency in plan development, analytics and reporting

Qualification & Experience:

• Network development experience
• Bachelor’s degree or equivalent leadership experience
• Master’s Degree with concentration in Nursing, Healthcare Administration or other related field
• 5 or more years of management and/or supervisory experience
• Managed Care experience
• Experience in TRICARE or other Federally regulated healthcare programs
• Experience coordinating the activities of diverse functions

Job Details:

Company: Humana

Vacancy Type: Full Time

Job Location: Dayton, OH, US

Application Deadline: N/A

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