Market Development Advisor

Profile

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.


20% Contribute to Humana Government Business profitability through effective PSA/TPSA leadership and management primarily through maximization of contract incentives and operational field metrics
20% 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.
20% Sustain TRICARE East Region contract excellence
10% Assist MTFs in all optimization efforts to include maximizing enrollment, efficient ROFR processes and development of appropriate CSAs and ERSAs
10% 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
10% 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
10% 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


Our Department of Defense Contract requires U.S. citizenship for this position
Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)
3 plus years of supervisor or leadership experience
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


Preferred Qualifications


Bachelor's or Master's Degree with concentration in Nursing, Healthcare Administration or other related field
Managed Care experience
Network development experience
MCG Criteria knowledge
Experience in TRICARE or other Federally regulated healthcare programs


Additional Information

Work Style : On-site office(s)

Work Location : Will alternate working onsite at the Navy Health Clinic & Air Force Medical Clinic in Charleston, SC

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Company info

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