Market Development Advisor - Medicaid Duals

Profile

Description

The Market Development Advisor provides support to assigned health plan and/or specialty companies relative to Medicare/Medicaid/TRICARE 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.

Responsibilities

The Market Development Advisor - Medicaid Duals 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. 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.

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

Required Qualifications

Bachelor's Degree

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

Works within deadlines, demonstrates independence, resourcefulness and self-management skills

Proficient with MS Excel, PowerPoint, Word

Preferred Qualifications

Master's degree in Business, Marketing, Finance/Accounting, or Health Administration

Past experience working in, or supporting, Medicaid operations

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com