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Internal Operations and Technology : Support efforts to improve the efficiency of health plan operations (utilization management, claims payment, provider contracting) to reduce friction for members, providers, and associates.
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Access : Ensure Humana members with behavioral health needs have access to appropriate and high-quality behavioral health care by optimizing network design, benefit design, care management, and referral pathways.
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Humana is a $90 billion (Fortune 40) market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong well-being. Innovation : Support behavioral health innovation including increasing access to virtual and specialty care and advancing value-based payment models.
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DescriptionHumana is a $90 billion (Fortune 40) market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong well-being. Metrics should be inclusive of quality, access, and financial metrics, such as medical trend reduction and administrative costs.
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As a company focused on the health and well-being of the people we serve, Humana is committed to advancing the employment experience and vitality of the associate community. Deep understanding and experience with behavioral health strategy and operations in a managed care setting.
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In this role, you will be a key enterprise leader, with responsibility for evolving Humana's behavioral health strategy, with a focus on our 5 million Medicare members. 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.
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This executive will be supported by the company’s established internal departments, including research, land acquisition, capital markets, pre-construction, prototypical architectural design, general contracting and accounting.
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We seek a high-performing individual who has a deep understanding of the US Market Access space with experience working with US Market Access customers, brand marketing, pricing analysis, contracting, and market access analytics.
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Coordinate internal resources (Clinical, Nursing, Operations, Sales, Marketing, Market Access, Contracting, Finance, BD, etc.) The VP, Regional Market Access is responsible for developing the market access & contracting strategy for the assigned area/region of the United States.
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Work with the marketing team in the development of tools and collateral on payer messaging for various segments, as well as support in tools and resources for non-market access teams on access, including education.
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We are a leader in the NYS workers’ compensation safety group insurance market. Underwriter/Auditor will be responsible for handling a large group of accounts and their associated brokers that make up Lovell’s Safety and General Group Workers’ Compensation Program with an emphasis on contracting-related business.
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The position requires knowledge of federal government contracting, the FAR, and DFARS. Additional factors considered in extending an offer include (but are not limited to) responsibilities of the job, education, experience, knowledge, skills, and abilities, as well as internal equity, alignment with market data, applicable bargaining agreement (if any), or other law.
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Your experience with market access and B2B, as well as your success in driving sophisticated contract negotiations and completion of contracts, PBM and managed care expertise, with a focus on the management of pharmacy budgets related to manufacturers, will be key.
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This includes leading qualitative and quantitative analyses to support payer strategy and drive decision making, tracking and communicating progress towards payer coverage goals, and partnering across brand, USV&A, Market Access and field sales team to enhance opportunities.
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Minimum 5 years market access experience required, including payer coverage. Broad knowledge of payer systems, including risk management systems and provider contracting. Train field sales organization, physicians/staff and key stake holders on the reimbursement landscape, patient access tools and resources.
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