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Humana · 1 month ago

Market Development Advisor

Cherry Point, NC

Full-time

Onsite

Mid, Senior Level

$95K/yr - $130K/yr

5+ years exp

Humana is committed to putting health first and is seeking a Market Development Advisor to support their health plan and specialty companies. This role involves managing TRICARE contracts, overseeing daily operations, and ensuring compliance while linking local actions to broader business strategies.

Health CareHealth InsuranceInsuranceVenture Capital

No H1B

Security Clearance Required

U.S. Citizen Only

Responsibilities

Provides support to assigned health plan and/or specialty companies relative to Medicare/Medicaid/TRICARE/Employer Group product implementation, operations, contract compliance, and federal contract application submissions

Works on problems of diverse scope and complexity ranging from moderate to substantial

Under the guidance of a Market Director, has full responsibility and accountability for the daily administration and management of the TRICARE contract within their assigned geography

Links local market-centric operational and tactical actions to success of the business strategies and goals of Humana Military, the Defense Health Agency (DHA), Defense Health Networks (DHNs) and Military Treatment Facilities (MTFs)

Oversees day-to-day TRICARE activities within a territory that includes designated Prime Service Areas (PSAs), Non-Prime Service Areas (NPSAs), MTFs, Coast Guard clinics, and National Guard and Reserve Units

Provides consultative services to DHN and MTF personnel to create and sustain a local high-quality integrated healthcare system congruent with the Military Health System (MHS) Quadruple Aim

Collects and analyzes data to develop, influence, and implement strategies and courses of action that support and improve DHN/MTF optimization, a ready medical force and medically ready service members

Directs daily TRICARE service delivery and network operations to include customer support and outreach activities, network adequacy, access to care standards, provider relationships, provider education, and provider management within the defined geographic area

Performs or oversights the timely and comprehensive review and response to TRICARE inquiries, and researches and resolves complaints, issues and concerns from beneficiaries, providers, and Government personnel

Actively participates in the development and deployment of Alternative Payment Methodologies and Demonstration Pilots aligned to Value Base Care models

Establishes and sustains positive working relationships and maintains effective communication in all encounters

Serves as the primary TRICARE point of contact for designated MTF Directors and their staff, beneficiaries who reside in the area, and community providers

Partners with community agencies to connect military families with local programs that target and enhance military health and resilience

Acts in the absence of the Market Director as requested and performs other duties as assigned

This position may require travel and work during uncommon duty hours to conduct oversight and outreach activities

Qualification

Network managementManaged care experienceLeadership experienceFiscal stewardshipMilitary Health SystemCommunication skillsProblem-solving skillsTeam collaboration

Required

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

Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services)

HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico

5 years of leadership and management experience

Experience with fiscal stewardship or responsibility for managing cost trends

Network management and development experience

Managed care experience

Experience coordinating the activities of diverse functions