Job Details

Director Group Market Operations - North

Company name
Humana Inc.

Location
Jersey City, NJ, United States

Employment Type
Full-Time

Industry
Manager, Operations, Executive

Posted on
Aug 20, 2021

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Profile

Description

The Director, Group Market Operations partners with the assigned Group Market Presidents on cost of care and profitable growth management, risk management and operations. The Market Operations Director requires an in-depth understanding of how organization capabilities interrelate across the segment and enterprise.

Responsibilities

Primary resource for aligned EG Market Presidents on all operations for the Employer Group Segment at the market level. Provides leadership and direction in the areas of financial and operational planning and day-to-day operations to aligned Market Presidents.

Provide fiscal and operational oversight of the market through development and oversight of the annual financial and FTE budget, financial planning and projections, risk management and operational metrics and reporting.

Partner with Employer Group Market Presidents, product, actuary and underwriting, as well as aligned provider and clinical partners, to improve cost of care trends and drive profitable growth within the aligned markets.

Proactively monitor and manage operational and cost of care performance across aligned markets in collaboration with regional and central resources, including Regional Presidents, Market Presidents, RVPs EG Provider Strategies, Market Medical Officers (MMOs), Finance, Underwriting, Actuary and Analytics. Clearly and consistently, tracks metrics and goals in order to influence and drive improvement and positive results within the region. Example areas of focus include:

Partners with Finance to maintain management and performance controls by identifying, tracking, measuring and analyzing data for aligned markets to highlight problems, prevent losses, contain costs and direct the development of process improvements.

Partners with Group, Provider Strategy, and Clinical Analytics teams to analyze all levers of market performance.

Orchestrates Local Market Trend Management for the aligned markets, including proactive Book of Business reviews to identify cost improvement opportunities.

Proactively monitor and manage profitable growth performance in aligned markets. Example area of focus includes:

Partners with Finance and Market Presidents to ensure market and individual Sales goals are set to meet segment new sales and retention goals, considering local market conditions and advancements in the business growth strategy

Partners closely with the Group Risk Management office to proactively mitigate regulatory and compliance risks within the aligned markets

Required Qualifications

At least 5 years of operations and/or finance experience in the health solutions industry

Proven track record of driving operational performance improvement.

Experience taking complex data and making it more accessible, understandable and usable for leaders to derive insights.

In-depth understanding of partner-functions within and outside the segment. Understanding of how organization capabilities interrelate across segments and enterprise-wide.

Knowledge of health plan finance and the compensation arrangements between health plans and providers.

Knowledge of risk arrangements and ability to influence these arrangements by providing performance data and recommendations for improvement.

Experience leading or influencing others

Proven experience working with Market Leaders and senior leaders within Humana

Understanding of corporate strategic goals; Understanding of Humana's clinical model

Excellent written and verbal communications skills

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Expert collaborator

Bachelor's Degree

Preferred Qualifications

Master's Degree

Additional Information

Work location is flexible

#MarketOpModel

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com

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