Description

Responsibilities

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. Ensure contractual compliance, coordinate and direct the efforts of HCO and WAH staff to optimize results. Responsible for maintaining good working relationships and maintaining communication as the primary point of contact with Military Treatment Facilities, Commanders and their staffs within assigned PSA. Coach and develop associates to improve performance and prepare for future positions.

Key Accountabilities –

• Contribute to Humana Government Business (HGB) profitability through effective PSA/TPSA leadership and management primarily through maximization of contract incentives and operational field metrics
• 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.
• 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
• 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
• 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
• Respond and assist in contingency operations in support of the MTF and network as needed

Our Department of Defense Contract requires U.S. citizenship for this position.

This role description in no way states or implies that the key accountabilities above are the only ones being performed by the individual(s) with this role description. The individual(s) may be called upon and required to follow other instructions or perform other duties and tasks requested by his or her supervisor, consistent with the purpose of the position, department and/or company objectives.

Required Qualifications

• Bachelor's degree
• 3 or more years of management and/or supervisory level experience
• Our Department of Defense Contract requires U.S. citizenship for this position
• TRICARE policy knowledge and Knowledge of Federally regulated healthcare programs
• Successfully receive interim approval for government security clearance (eQIP – Electronic Questionnaire for Investigation Processing)
• Experience coordinating the activities of diverse functions
• Excellent written and oral communication skills
• Ability to analyze data and make informed recommendations
• Proven track record in developing working relationships and influencing throughout the matrix environment
• Demonstrated proficiency in plan development, analytics and reporting
• Proficient with Microsoft office products to include Word, Excel and Outlook
• Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or working outside of their homes

Work at Home/Remote Requirements (When not onsite)

• WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense
• A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

• Master’s Degree with concentration in Nursing, Healthcare Administration or other related field
• Managed Care experience
• Network development experience
• MCG Criteria knowledge

Additional Information

Work Style: On-site office(s)/Remote
Work Location(s):

• Will work onsite a few days a week at the Military Treatment Facility (MTF) at Captain James A. Lovell Federal Health Care Center in Great Lakes, IL.
• Additional travel to other military installations throughout Wisconsin and Michigan.

Job Type: Full-time

Pay: $95,000.00 - $120,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Professional development assistance
• Tuition reimbursement
• Vision insurance

Schedule:

• Monday to Friday

Ability to commute/relocate:

• North Chicago, IL 60064: Reliably commute or planning to relocate before starting work (Required)

Application Question(s):

• Successfully receive interim approval for government security clearance (eQIP – Electronic Questionnaire for Investigation Processing)

Experience:

• Contract management: 3 years (Required)
• contract Compliance: 3 years (Required)
• financial performance: 3 years (Required)
• supervise/management of Community Liaisons: 3 years (Required)
• Healthcare management and/or supervisory with contracting: 3 years (Required)
• Knowledge of Federally regulated healthcare programs: 1 year (Required)
• matrix environment: 1 year (Required)
• proficiency in plan development, analytics and reporting: 1 year (Preferred)
• Network management: 3 years (Required)

Willingness to travel:

• 25% (Required)

Work Location: Hybrid remote in North Chicago, IL 60064

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