Medicaid Market Development Advisor at Humana

Louisville, Kentucky, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Bachelor's degree
3+ years' experience with Medicaid/Medicare/Employer Group operations/Category Management/Supplier Management
3+ years managing large scale projects and cross functional teams
Success in developing working relationships within a highly matrixed business environment
Ability to analyze data and make informed recommendations
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
Master's degree
Experience responding to state and/or federal government solicitations
Experience developing relationships with key stakeholders to understand and improve the market

Responsibilities

Provides support to assigned health plan and/or specialty companies relative to Medicaid product implementation, operations, contract compliance, and federal contract application submissions
Works on problems of diverse scope and complexity ranging from moderate to substantial
Serves as the primary liaison for all assigned categories and third parties
Ensures that assigned health plans are meeting or exceeding corporate Medicaid performance benchmarks
Maintains relationships with internal business partners
Provides ongoing contract oversight as a relationship manager
Holds operational meetings to validate that all services being provided are meeting contract SLAs, review projects, and discuss relevant topics or issues
Facilitates Joint Operations Committee to review key performance metrics and ongoing monitoring results and foster cross functional discussion
Collects and analyzes reporting data
Prepares performance summary reports
Manages any corrective action plans issues for identified deficiencies
Creates and manages category strategies for assigned relationships
Facilitates RFx events as needed

Skills

Key technologies and capabilities for this role

MedicaidMedicareCategory ManagementSupplier ManagementProject ManagementCross-functional TeamsData AnalysisContract OversightSLA ManagementPerformance ReportingRFxMatrixed Environment

Questions & Answers

Common questions about this position

What are the required qualifications for the Medicaid Market Development Advisor role?

A Bachelor's degree is required, along with 3+ years' experience with Medicaid/Medicare/Employer Group operations/Category Management/Supplier Management, 3+ years managing large scale projects and cross functional teams, success in developing working relationships in a highly matrixed environment, ability to analyze data and make informed recommendations, and passion for improving consumer experiences.

What is the work arrangement for this position?

The role supports Home or Hybrid Home/Office employees, requiring self-provided internet with at minimum a download speed of 25 Mbps and an upload speed of 10 Mbps.

What does an ideal candidate for this role look like?

An ideal candidate exercises independent judgment on complex issues, works under minimal supervision, uses independent judgment requiring analysis of variable factors, and is passionate about improving consumer experiences.

What is the salary or compensation for this position?

This information is not specified in the job description.

What is the interview process like for this role?

The hiring process uses HireVue interviewing technology to connect and gather information on relevant skills and experience at a convenient time.

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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