Become a part of our caring community and help us put health first
The Senior Market Development Professional provides support to assigned health plan and/or specialty companies relative to Medicare/Medicaid/TRICARE product implementation, operations, contract compliance, and federal contract application submissions. The Senior Market Development Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.Location: remote
The Senior Market Development Professional serves as the primary resource on regulations for all assigned health plans. Ensures that assigned health plans are meeting or exceeding corporate Medicare/Medicaid/TRICARE performance benchmarks. Maintains relationships with regulators within a region.
Develop and maintain Medicaid Mental Health Parity and Addiction Equity Act (MHPAEA) compliant policy
Perform analysis for implementation (including fee schedules) to determine potential services/codes for creation of Preauthorization List (PAL) Initial set up through aggregation and review of state fee schedules, manual and other Humana PALs.
Make recommendations to market and clinical leaders and coordinate determination of code sets/categorization of codes
Stand up and lead Medicaid PAL governance meetings/framework/minutes/documentation
Create and maintain PALs (Web copy/Mentor CIT/Mentor CS/Code Repository)/business rules
Draft and obtain approval for any written communication to the providers regarding changes in preauthorization requirements, including those through mail and on the web.
Coordinate and implement across all PALs new code roll outs.(quarterly)
Assist with development of dashboard (and maintenance with code changes)
Analyze reporting for presentation, review and to provide recommendations in Medicaid leader meetings
Use your skills to make an impact
Role Essentials
Bachelor's degree or equivalent work experience
5 or more years of payor, project management and/or Medicaid experience
Excellent communication skills, both oral and written
Experience implementing and measuring success on complex health-related initiatives
Experience facilitating meetings
Experience managing projects
Strategic thinker with ability to work independently
Strong relationship building skills
Strong analytical skills
Process-focused, with ability to leverage and enhance existing processes
Role Desirables
Healthcare experience
Additional Information
Humana is an organization with careers that change lives—including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.
Scheduled Weekly Hours
40Pay 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.
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.
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 because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.
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