Senior Healthcare Network Consultant

Humana

1d • Remote

About The Position

Become a part of our caring community Senior Network Performance Professional / Consultant at Humana, you will help enhance provider performance and advancing Humana's mission to deliver high-quality healthcare. You will work with providers to improve their STARs ratings and overall performance through strategic initiatives and relationship-building. You will report to the Manager, Network Performance. As the Senior Network Performance Professional / Consultant you will Provider Collaboration: Work with providers to define and improve their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies. Stars/Quality Program Expertise: Serve as an expert on the Stars/Quality program, educating physician groups on HEDIS, patient safety, and patient experience. Collaborate to develop tailored action plans and communicate actionable insights to improve performance. Performance Improvement: Monitor and analyze provider performance data to identify areas for improvement. Implement strategies to enhance outcomes and provide ongoing support to providers. Resource Liaison: Act as a liaison for providers to access Humana resources, educating and encouraging providers on the use of self-serve tools. Facilitate communication between providers and our teams to ensure seamless access to necessary support. Reward Programs: Educate provider groups on reward programs and target metrics, collaborating to achieve established goals. Monitor and report on the effectiveness of reward programs, making recommendations for enhancements. Provider Abrasion Resolution: Resolve provider abrasion issues, ensuring a positive and collaborative relationship between Humana and its providers. Implement strategies to minimize provider abrasion and enhance overall satisfaction. Internal Collaboration: Partner with our teams to track and report market performance, ensuring alignment with organizational goals. Use your skills to make an impact

Requirements

• 2 or more years of Experience with Medicare or managed care
• Live in CST or EST and work during 8am-5pm CST or EST
• 3 or more years of NCQA HEDIS measures, PQA Measures, CMS Star Rating System and CAHPS/HOS survey system
• 1 or more years of understanding of Consumer / Patient Experience
• 2 or more years of experience building relationships with physician groups and influencing execution of recommended strategy
• 1 or more years of experience with focus on process and quality improvement
• Comprehensive knowledge of all Microsoft Word, Excel and PowerPoint

Nice To Haves

• Bachelor's Degree
• Lives in the region IN, KY, MI, OH, WV
• Experience presenting to internal and external customers, including high-level leadership
• Progressive experience with interoperability solutions in Healthcare
• Experience with Medicare Risk Adjustment and/or medical coding
• Understanding of metrics, trends and the ability to identify gaps in care
• 1 or more years' experience with tools such as Power BI, Tableau, Qlikview

Responsibilities

• Provider Collaboration: Work with providers to define and improve their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies.
• Stars/Quality Program Expertise: Serve as an expert on the Stars/Quality program, educating physician groups on HEDIS, patient safety, and patient experience. Collaborate to develop tailored action plans and communicate actionable insights to improve performance.
• Performance Improvement: Monitor and analyze provider performance data to identify areas for improvement. Implement strategies to enhance outcomes and provide ongoing support to providers.
• Resource Liaison: Act as a liaison for providers to access Humana resources, educating and encouraging providers on the use of self-serve tools. Facilitate communication between providers and our teams to ensure seamless access to necessary support.
• Reward Programs: Educate provider groups on reward programs and target metrics, collaborating to achieve established goals. Monitor and report on the effectiveness of reward programs, making recommendations for enhancements.
• Provider Abrasion Resolution: Resolve provider abrasion issues, ensuring a positive and collaborative relationship between Humana and its providers. Implement strategies to minimize provider abrasion and enhance overall satisfaction.
• Internal Collaboration: Partner with our teams to track and report market performance, ensuring alignment with organizational goals.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Number of Employees: 5,001-10,000 employees