Humana

Market Development Advisor

South Carolina, United States

Not SpecifiedCompensation
Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Health Insurance, HealthcareIndustries

Requirements

Candidates must possess a minimum of three years of experience in provider relations, engagement, communications, and/or health plan operations. A minimum of three years of experience with value-based contracting strategy/analysis and two years of process creation or improvement experience are also required. The role demands strategic thinking, strong problem-solving abilities, excellent interpersonal, organizational, written, and oral communication skills, and proficiency in MS Office applications including SharePoint, Teams, Word, PowerPoint, Outlook, and Excel. A Bachelor's or Master's degree and familiarity with SC Medicaid/government healthcare are preferred.

Responsibilities

The Market Development Advisor will provide support for Medicaid product implementation, operations, contract compliance, and federal contract applications. Key duties include advising on Provider Relations and Network Operations performance, driving network strategic initiatives, establishing infrastructure to measure KPIs, developing and managing the Provider Support Plan and state reporting, and overseeing provider communications and training. The advisor will also monitor performance against contractual commitments, perform root cause analysis for data inaccuracies, and facilitate workgroup calls to improve data accuracy and network strategy.

Skills

Medicaid product implementation
Operations support
Contract compliance
Federal contract application submissions
Provider Services
Strategic operations
Process development
Process improvement
Standardization
Efficiency
State reporting
Provider communication
Provider materials development
Market implementation
Cross-functional partnership
Independent judgment
Analysis
Provider Relations
Provider Engagement
Network Operations
Network strategic initiatives
Tactical execution
KPI measurement
Managed care contractual requirements
Provider Support Plan

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters
1961Year Founded
IPOCompany Stage
Social Impact, HealthcareIndustries
10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.
Rising medical costs and tightening Medicare reimbursements may strain financial performance.
Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.
The company emphasizes inclusivity, offering free language interpreter services for accessibility.
Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.
The company is the first insurer to cover TMS therapy for adolescent depression.
Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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