Senior Network Performance Consultant

Humana

4d • Remote

About The Position

Become a part of our caring community and help us put health first As a Senior Network Performance Professional / Consultant at Humana, you will play a pivotal role in enhancing provider performance within the SouthEast Region 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 strong relationship-building. You will report to the Manager, Network Performance. As the Senior Network Performance Professional / Consultant you will: Work with SouthEast Region providers to define and advance their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies Recommend execution strategies and monitor performance toward these goals Actively monitor and analyze provider performance data to identify areas for improvement Be 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 applicable insights to improve performance Implement strategies to enhance outcomes and provide ongoing support and guidance to providers Be a liaison for providers to access Humana resources, educating and encouraging providers on the use of self-serve tools Educate provider groups on reward programs and target metrics, collaborating to achieve established goals Monitor and reports on the effectiveness of reward programs, making recommendations for enhancements Resolve provider abrasion issues, ensuring a positive and collaborative relationship between Humana and its providers Collaborate with teams to drive initiatives that support provider performance improvement Use your skills to make an impact

Requirements

• Live in NC, SC, GA or VA
• 5 or more years' experience with Medicare and/or managed care
• Understanding of NCQA HEDIS measures, PQA Measures, CMS Star Rating System and CAHPS/HOS survey system
• Experience building relationships with physician groups and influencing execution of recommended strategy
• Comprehensive knowledge of all Microsoft Office Word, Excel and PowerPoint
• Experience presenting to internal and external customers, including high-level leadership
• Work hours 8am-5pm EST

Nice To Haves

• Bachelor's Degree
• Experience with Medicare Risk Adjustment
• Progressive experience with interoperability solutions in Healthcare

Responsibilities

• Work with SouthEast Region providers to define and advance their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies
• Recommend execution strategies and monitor performance toward these goals
• Actively monitor and analyze provider performance data to identify areas for improvement
• Be 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 applicable insights to improve performance
• Implement strategies to enhance outcomes and provide ongoing support and guidance to providers
• Be a liaison for providers to access Humana resources, educating and encouraging providers on the use of self-serve tools
• Educate provider groups on reward programs and target metrics, collaborating to achieve established goals
• Monitor and reports on the effectiveness of reward programs, making recommendations for enhancements
• Resolve provider abrasion issues, ensuring a positive and collaborative relationship between Humana and its providers
• Collaborate with teams to drive initiatives that support provider performance improvement

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