Market Development Advisor

Humana • New Bern, NC

9d

About The Position

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 works on problems of diverse scope and complexity ranging from moderate to substantial. This individual, under the guidance of a Market Director, has full responsibility and accountability for the daily administration and management of the TRICARE contract within their assigned geography. This critical role links local market-centric operational and tactical actions to success of the business strategies and goals of Humana Military, the Defense Health Agency (DHA), Defense Health Networks (DHNs) and Military Treatment Facilities (MTFs). Oversees day-to-day TRICARE activities within a territory that includes designated Prime Service Areas (PSAs), Non-Prime Service Areas (NPSAs), MTFs, Coast Guard clinics, and National Guard and Reserve Units. Provides consultative services to DHN and MTF personnel to create and sustain a local high-quality integrated healthcare system congruent with the Military Health System (MHS) Quadruple Aim. Collects and analyzes data to develop, influence, and implement strategies and courses of action that support and improve DHN/MTF optimization, a ready medical force and medically ready service members. Directs daily TRICARE service delivery and network operations to include customer support and outreach activities, network adequacy, access to care standards, provider relationships, provider education, and provider management within the defined geographic area. Performs or oversights the timely and comprehensive review and response to TRICARE inquiries, and researches and resolves complaints, issues and concerns from beneficiaries, providers, and Government personnel. Actively participates in the development and deployment of Alternative Payment Methodologies and Demonstration Pilots aligned to Value Base Care models. Establishes and sustains positive working relationships and maintains effective communication in all encounters. Serves as the primary TRICARE point of contact for designated MTF Directors and their staff, beneficiaries who reside in the area, and community providers. Partners with community agencies to connect military families with local programs that target and enhance military health and resilience. Acts in the absence of the Market Director as requested and performs other duties as assigned. This position may require travel and work during uncommon duty hours to conduct oversight and outreach activities. Use your skills to make an impact

Requirements

• Our Department of Defense Contract requires U.S. citizenship for this position
• Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services)
• HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico.
• 5 years of leadership and management experience
• Experience with fiscal stewardship or responsibility for managing cost trends
• Network management and development experience
• Managed care experience
• Experience coordinating the activities of diverse functions

Nice To Haves

• Bachelor's degree
• Experience in the Military Health System
• Experience with TRICARE contracts

Responsibilities

• Oversees day-to-day TRICARE activities within a territory that includes designated Prime Service Areas (PSAs), Non-Prime Service Areas (NPSAs), MTFs, Coast Guard clinics, and National Guard and Reserve Units.
• Provides consultative services to DHN and MTF personnel to create and sustain a local high-quality integrated healthcare system congruent with the Military Health System (MHS) Quadruple Aim.
• Collects and analyzes data to develop, influence, and implement strategies and courses of action that support and improve DHN/MTF optimization, a ready medical force and medically ready service members.
• Directs daily TRICARE service delivery and network operations to include customer support and outreach activities, network adequacy, access to care standards, provider relationships, provider education, and provider management within the defined geographic area.
• Performs or oversights the timely and comprehensive review and response to TRICARE inquiries, and researches and resolves complaints, issues and concerns from beneficiaries, providers, and Government personnel.
• Actively participates in the development and deployment of Alternative Payment Methodologies and Demonstration Pilots aligned to Value Base Care models.
• Establishes and sustains positive working relationships and maintains effective communication in all encounters.
• Serves as the primary TRICARE point of contact for designated MTF Directors and their staff, beneficiaries who reside in the area, and community providers.
• Partners with community agencies to connect military families with local programs that target and enhance military health and resilience.
• Acts in the absence of the Market Director as requested and performs other duties as assigned.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees