Description
The Market Development Advisor – Medicaid Provider Service Operations provides support to assigned health plan and/or specialty companies relative to Medicaid Group product implementation, operations, contract compliance, and federal contract application submissions. The Market Development Advisor works on problems of diverse scope and complexity ranging from moderate to substantial.
Responsibilities
The Market Development Advisor – Medicaid Provider Service Operations is responsible for driving operational excellence for end to end Provider Service and Experience in the Ohio Department of Medicaid Managed Care Contract. Ensures that assigned health plans are meeting or exceeding corporate Medicaid performance benchmarks. Maintains relationships with internal and external key stakeholder including the Ohio Department of Medicaid. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision as the provider services Medicaid subject matter expert. Uses independent judgment requiring analysis of variable factors and determining the best course of action. This position works on problems of diverse scope and complexity ranging from moderate to substantial. This is a highly collaborative role requiring critical thinking and problem solving skills, independence, tactical execution on strategy, and attention to detail. This position reports to the Director of Provider Experience and Network Transformation.
Key Responsibilities
- Contributes to the operational success of Humana Healthy Horizons Provider Service and Experience Organization in accordance with the Ohio Department of Medicaid Managed Care contract
- Serve as Lead/Chief of Staff to drive provider relations strategy, process improvement and project management
- Supports Director in the oversight of the Ohio Medicaid’s plan’s provider relations and practice transformation to ensure Perfect Provider Experiences and compliance with all provider services requirements of the ODM Managed Care contract
- Solve complex business challenges and seeks to alleviate provider service disruptions and provider abrasion
- Supports Director in the development and execution of Physician Advisory Councils
- Works collaboratively with key stakeholders across the enterprise and externally with community and business partners including the Ohio Department of Medicaid
- Analyze internal and external data in support of development of policy, process, strategy and improvement
- Monitors performance against key performance indicators, contract requirements and compliance.
Required Qualifications
- Bachelor’s Degree
- 5+ years experience with Medicaid managed care operations, provider relations, network operations, claims knowledge and/or operations, and knowledge of value based provider arrangement and reimbursement methodology
- 3 – 5 years managing mid-large scale projects and cross functional teams
- Proven expertise in driving operational efficiencies and management of processes and procedures. Adept at managing processes from concept to completion ensuring timely on-target, on-budget results
- Ability to analyze data and make informed recommendations
- Demonstrated skills in executing on strategic playbooks or roadmaps in alignment with organizational goals
- Ability to identify, structure and solve complex business problems
- Highly developed computer skills in Microsoft Office applications
- Excellent interpersonal, organizational, written, and oral communication and presentation skills with proven experience developing and delivering presentations to members of the leadership team
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
- WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10×1 (10mbs download x 1mbs upload) is required.
Preferred Qualifications
- Master’s degree
- Experience responding to state and/or federal government Request of Proposals, Readiness Review and other solicitations
- Experience developing relationships with key stakeholders to understand and improve the market
Additional Information
Position can be Office/Remote/WAH
Occasional travel may be required
For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are ahealthcarecompany committed to putting health and safety first for our members, patients, associates, and the communities we serve.
If progressed to offer, you will be required to:
- Provide proof of full vaccinationor commit to testing protocols.OR*
- Provide proof of applicable exemption including any required supporting documentation
Medical, religious, state and remote-only work exemptions are available.
Scheduled Weekly Hours
40