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The Market Development Advisor provides support to assigned health plan and/or specialty companies relative to Medicaid 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 (South Carolina) reports directly to the South Carolina Associate Director, and is responsible for strategic and tactical support of the Provider Services team. Responsibilities will include strategic operations of the team, process development and improvement to drive standardization and efficiencies across the team, completing related state reports, and developing and executing upon a provider communication and provider materials development strategy. Initially, the advisor will play a key role in supporting new market implementation activities. This position partners cross-functionally within the market and across the enterprise on matters of significance. This position 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.
Key Role Objectives
Advise Associate Director regarding Provider Relations and Provider Engagement and Network Operations performance.
Drives network strategic initiatives and tactical execution, ensuring alignment to financial, operational and clinical goals.
Establish infrastructure to measure KPIs and other metrics to ensure compliance with related managed care contractual requirements
Develop initial and manage annual updates of the market's Provider Support Plan, in partnership with the Associate Director, as well as any other related required state reporting
Oversee provider communications (fax blasts, emails, bulletins, website or provider portal content updates) end to end process, including development of content and management through the approval process
Manage provider training and education strategy, including advising on and/or creating market-based provider materials and contributing to provider manual and required training materials
Monitor performance against key performance indicators and contractual commitments and requirements to ensure compliance.
Perform root cause research on load inaccuracies that result in provider not reflecting correctly on state provider files and/or directory. Relay to the appropriate department to address the issue.
Facilitate workgroup calls/meetings/discussions to seek support with data and/or processes that contribute to network strategy and data accuracy success.
Use your skills to make an impact
Required Qualifications
Minimum three, (3) years of experience, in provider relations or engagement, provider communications and education, and/or related health plan operations
Minimum three, (3) years of experience with value-based contracting strategy/analysis
Minimum two, (2) years of process creation or improvement experience
Strategic thinker with the ability to identify, prioritize, and solve complex business problems
Excellent interpersonal, organizational, written, and oral communication and presentation skills with proven experience writing and delivering presentations to members of the management team and internal business partners
Proficient in MS Office Applications including SharePoint, Teams, MS Word, PowerPoint, Outlook, and Excel
Excellent written and verbal communication skills
Preferred Qualifications
Bachelor's or Master's degree
Strong familiarity with SC Medicaid/government healthcare to actively advocate for network priorities with internal stakeholders and shared services
Proficiency in Microsoft Access
Workstyle: Remote Work at Home
Location: Prefer South Carolina
Schedule: M-F 8AM-5PM Eastern Time
Travel: Periodic travel 10% as business needs
Work at Home Guidance At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; 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.
Interview Format After submitting your application, if you are selected to move forward you will receive an email to complete the Virtual Job Experience (VJE). This is an online activity where you will learn more about Customer Care jobs at Humana, try out some of the most common job tasks, and tell us more about yourself. Most people complete the VJE in approximately 30 minutes. To complete it, you will need a smart phone, computer or tablet with internet access, and speakers/headphones. We do not make job offers to candidates that do not complete the VJE. The email will come from vjtadmin@mg.jobtryout.net, please add to your contacts or safe senders list to avoid this going to your spam folder.
SSN 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 Humana@myworkday.com with instructions on how to add the information into your official application on Humana's secure website.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
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.
$94,900 - $130,500 per year
This 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.
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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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.
