Advisor, Medicaid Provider & Network Strategy

at Humana in Springfield, Illinois, United States

Job Description

Become a part of our caring community and help us put health first

The Advisor, Medicaid Provider & Network Strategy will be accountable for leading the development of Humana Healthy Horizon’s (Medicaid) provider & network market entry strategy for its Medicaid growth markets. This strategist will lead data-driven research oriented strategic advisement in the development of strategies that produce robust, adequate, and accessible networks. The Advisor will also drive the development of competitive & innovative provider & network strategies to support request for proposals (RFPs) and market entry. Such strategies include, but are not limited to access to care, practice transformation, provider relations, alternative sites of care, and value-based purchasing. The position requires an in-depth understanding of how organizational capabilities interrelate within the enterprise to develop and execute on network strategy. This position exercises strong project management skills, analysis of variable source information, independent judgment, and decision making on complex issues related to the job duties and related tasks. Up to 10% travel is expected for this role.

We are seeking an experienced strategist with a track record of synthesizing and evaluating multiple sources of qualitative and quantitative data to define network priorities and build solutions. Excellent interpersonal, organizational, written, and oral communication and presentation skills with proven experience writing and delivering presentations to members of the management team and internal business partners will be critical in this role.

Key responsibilities for this role include:

+ Oversees the creation of a playbook that drives Humana’s provider & network market entry strategy decisions.

+ Works cross functionally to seek consult and provide advisement on a proposed network build approach and timeline based on analysis of internal and external source data and managed care program requirements.

+ Drives market competitor analysis and the evaluation existing managed care requirements to assess gaps in Humana’s pre-rfp & market entry provider & network strategy.

+ Leads network workstream meetings, including content creation from the market development kick-off through the initiation of the network build.

+ Presents to Medicaid senior leadership regular progress updates on Provider & Network Strategy in assigned markets.

+ Develops provider & network strategies based on insights