Humana Director, Vision Business Development in Boston, Massachusetts
The Director, Market Development 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 Director, Market Development requires an in-depth understanding of how organization capabilities interrelate across the function or segment.
Champion the vision business across Humana's commercial, Medicare, and Medicaid lines of business with internal stakeholder partners and externally with Humana's vision partner. Own the vision partnership relationship and work within Humana's matrixed environment to align objectives and drive accountability with key stakeholders. Deliver continuous improvement in partnership management, operational management, network management, and innovations that enables business growth within a proactive partnership governance framework.
The Director, Market Development 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. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy.
This is a remote opportunity within the continental U.S
Vision Partnership Management
Own the overall relationship with Humana's vision partner. Build and maintain relationships with key stakeholders internally and externally. Drive accountability with appropriate internal and external stakeholders to make progress against large scale partnership improvement initiatives and to support timely issue resolution.
Conduct business reviews and strategy sessions, quarterly at minimum, that communicate progress against key priorities and create feedback loops that allow us to continually prioritize key initiatives on a 6 quarter rolling basis.
Establish a vendor scorecard - to measure performance against goals and to clearly communicate priorities both internally and externally.
Develop a contract management oversight process that allows us to leverage best contract management practices at Humana; drive resolution for needed contract changes.
Vision Operational Management
Establish clear governance processes to meet existing and emerging compliance requirements across all lines of business and functions; including support for internal audit programs.
Establish clear governance processes around member and provider service metrics and performance guarantees - at both the partnership and client levels.
Leverage Humana's Third Party Risk Management framework and partner with the Operational Risk Management (ORM) team to establish policies and procedures that proactively identifies and mitigates operational risk. Partner with internal audit, delegation compliance, and ORM teams as needed to drive timely resolution for identified risks and opportunities with vision partner.
Vision Network Management
Collaborate with vision partner, specialty leadership team, sales, underwriting, and the proposal team to allow Humana to appropriately position our vision business for success in requests for proposal.
Develop process to identify, assess, and communicate network contracting priorities across all lines of business and different network configurations.
Understand network contracting, directory, and network adequacy from both a regulatory and contractual requirements/obligations perspective. Ensure we maintain industry appropriate and compliant business practices across commercial, Medicare, and Medicaid.
Understand the vision competitive environment and industry trends that impact our ability to compete in a partnership model. Advise specialty leadership team and internal partners on the vision business and collaborate to develop vision strategies in support of each business's overall strategic objectives.
Drive accountability for innovation with aligned partners through scorecard alignment, OKR framework, quarterly business reviews, and relationship building.
Create connections between internal Humana teams and vision partner teams to explore vision partner industry intelligence, capabilities, and insights.
Understand vision partner objectives and market positioning.
Drives for Excellence
Coaching and Team Development
Commercial and/or Medicare regulatory experience
5 or more years of management experience
Proven experience working with Market Leaders and senior leaders within Humana
Understanding of corporate strategic goals; Understanding of Humana's clinical model
Prior demonstrated success in network management or provider relations
Excellent written and verbal communications skills
Experience in creating, and executing on, an enterprise scale business development strategic plan
Solid track record of hiring and developing talent and preparing associates for roles of broader and greater responsibility
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Prior vision insurance industry experience
External vendor partnership experience
Experience working in a matrixed organization
- Open to remote working style with some required travel
Scheduled Weekly Hours
- Humana Jobs