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

Humana Military, a wholly owned subsidiary of Humana Inc (A $100 billion, Fortune 38 market leader in integrated healthcare), works with the federal government to provide high-quality service and cost-effective platforms to support the needs of current and former military members, and their families. Since 1996, Humana Military has served the Department of Defense (DoD) through the TRICARE health program. Through our support of TRICARE and other military and Veterans-focused healthcare programs over three decades, we have stood as an essential partner to the government to provide better health outcomes and simplified experiences for millions across the United States who have earned the best care possible in recognition of their service.

The Market Development Advisor, 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. This critical role 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.

The **Market Development Advisor** 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.

KEY ACCOUNTABILITIES

**20%** Contribute to Humana Military profitability and sustained performance excellence through effective leadership and management. Examples of this work include:

+ a. Operating within allocated budget

+ b. Implementing activities that maximize contract incentives

+ c. Developing and executing data-driven strategies, plans, and actions that increase operational efficiency and/or generate additional revenue

+ d. Achieving performance outcomes that meet or exceed contract requirements

+ e. Auditing work products to ascertain quality and opportunities to improve policies, procedures, and performance

**20%** Optimize DHN and MTF capacity and capability to maximize medically ready forces and ready medical forces. Examples of this work include:

+ a. Creating and sustaining strong, collaborative relationships with MTF Directors and their staff

+ b. Utilizing market optimization data to monitor, identify, and report MTF leakage to the network, MTF use of KSA referrals, referral management patterns, beneficiary healthcare utilization, and health outcomes

+ c. Developing recommended actions and influencing decisions related to MTF enrollment, KSA referrals, and recapture opportunities

+ d. Advocating use of Internal Resource Sharing, Clinical Support Agreements, and External Resource Sharing, and implementing appropriate MTF optimization tools based on business case analysis

+ e. Marketing MTF capabilities to civilian providers and beneficiaries to promote increased use of MTF services and GME programs

+ f. Coordinating provider collaboration events that introduce civilian providers to the installation’s mission and uniqueness of caring for a military population

+ g. Participating in contingency exercises and supporting community needs during contingency operations that impact the availability of MTF and/or network healthcare services, including performing network assessments and proactive customer outreach

**20%** Manage daily operations of a high value network that integrates direct care and purchased care health systems within the assigned geography. Examples of this work include:

+ a. Directing daily network operations in designated PSAs and NPSAs

+ b. Routinely assessing network adequacy within designated PSAs/NPSAs and taking actions to close gaps, including by partnering with the provider contracting team

+ c. Proactively monitoring, identifying and addressing deviations in access to care standards

+ d. Performing, or oversighting performance of, activities that produce strong provider engagement and relationships

+ e. Consulting with network providers to advance improved service delivery and health outcomes

+ f. Participating in the development and implementation of Alternative Payment Methodologies and selected DHA Demonstration Pilots aligned to Value Based Care models

+ g. Collaborating with Provider Network Operations and other senior professionals across multiple departments to enhance the accuracy, reliability, and timeliness of provider data

**20%** Direct successful Government, provider, and beneficiary customer support activities. Examples of this work include:

+ a. Identifying, evaluating, and achieving timely and appropriate resolution of Government, beneficiary, and provider inquiries, problems, and concerns by assisting with provider contracting, provider credentialing, beneficiary eligibility, referrals, appointments, claims, and TRICARE benefits

+ b. Overseeing or conducting on-site or virtual, group or individual, education and briefings for Government personnel, beneficiaries and providers that may occur during other than routine duty hours

+ c. Interpreting, communicating, and applying TRICARE policies, Memorandum of Understandings with DHA and interagency contractors, the DHN Statement of Responsibility, as well as other policies and procedures as indicated

+ d. Utilizing feedback in TRICARE surveys to identify opportunities and target actions to improve

**10%** Further the engagement, well-being, and advancement of Humana Military associates and enhance the work experiences of all. Examples of this work include:

+ a. Coordinating or conducting onboarding and job-specific education and training to close gaps in associate knowledge, skills, and abilities

+ b. Performing coaching and mentoring activities

+ c. Creating and supporting individual professional development plans in close collaboration with the associate

**5%** Establish and maintain partnerships with community agencies to connect military families with local programs that target and enhance military health and resilience. Examples of this work include:

+ a. Ensuring local resources are posted to findhelp.org and suggesting programs that would help close gaps

+ b. Identifying, researching, and forwarding for sponsorship consideration local community activities that focus on advancing the health and wellness of military families

**5%** Accomplish administrative tasks and other duties as assigned. Examples of this work include:

+ a. Documenting interactions

+ b. Processing transactions

+ c. Collecting and validating data to complete information requested by internal and external customers

+ d. Acting in the absence of the Market Director upon request

**_This position description in no way states or implies that the key accountabilities above are the only ones being performed by the individual(s) with this role description. The individual(s) may be called upon and required to follow other instructions or perform other duties and tasks requested by his or her supervisor, consistent with the purpose of the position, department and/or company objectives_** .

Use your skills to make an impact

Required Qualifications

+ BS/BA degree in Business, Health Care Administration or a related field

+ Minimum of five years of leadership and management experience

+ Previous experience with fiscal stewardship and/or responsibility for managing cost trends/analysis

+ Provider network management experience

+ Experience with analysis of data and making decisions based on data

+ Advanced organizational, communication, negotiation and presentation skills

+ •Must demonstrate strategic capabilities with strengths in critical thinking and innovative problem-solving skills

+ Demonstrated background with improving the experience and satisfaction of customers

+ Excellent interpersonal skills and ability to develop collaborative working relationships across multiple functional areas in the organization and with customers

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

+ **Successfully receive approval for government security clearance (Via National Background Investigation Services NBIS)**

+ **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**

Preferred Qualifications

+ Experience with TRICARE policies and/or the military health care delivery system

+ Previous experience with TRICARE contracts

+ Prior clinical experience in direct patient care

Additional Information

**Work Style** : On-site/Office

**Work Location(s)/Hours** :

+ This position will work onsite, Monday through Friday at Wright Patterson AFB in Dayton, Ohio.

+ Must be able to work within the hours of 7 a.m. to 4 p.m. EST

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$94,900 - $130,500 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.