Senior Network Performance Professional

Humana • Oklahoma City, TX

20h • Remote

About The Position

As a Senior Network Performance Professional at Humana, you will play a pivotal role in enhancing 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 strong relationship-building. This role offers a unique opportunity to leverage your expertise in healthcare provider relations to influence operational decisions and support the overall success of the organization. Operates with a high degree of independence, often determining methods/approach to work and establishing own work priorities and timelines. Work consists of tasks that are moderately complex, requiring minimal instructions to achieve solutions. May provide coaching and/or review the work of lower-level associates. Makes decisions on moderately complex issues; exercises discretion and judgment over policies and own approach/priorities. Work impacts the achievement of results for the department and begins to influence the department's strategy.

Requirements

• Bachelor's Degree in Business, Finance, Health Care/Administration, RN or a related field, or equivalent work experience
• Experience with Medicare and/or managed care
• Understanding of NCQA and CMS Stars Rating System (HEDIS measures, PQA Measures, and CAHPS/HOS survey system)
• Understanding of clinical utilization and levers to improve performance
• Understanding of and ability to drive interoperability
• Understanding of Consumer/Patient Experience
• Experience building relationships with physician groups and influencing execution of recommended strategy
• Strong communication and presentation skills, both verbal and written, and experience presenting to internal and external customers, including high-level leadership
• Experience with focus on process and quality improvement
• Understanding of metrics, trends and the ability to identify gaps in care
• Comprehensive knowledge of all Microsoft Office Word, Excel and PowerPoint
• Must be able to work during 8-5pm (Central Time Zone)
• Willingness to travel a minimum of 25% within region (Texas, Arkansas, or Oklahoma)

Nice To Haves

• Master's Degree in Business, Finance, Health Care/Administration, RN or a related field
• Experience with Medicare Risk Adjustment and/or medical coding
• Proven organizational and prioritization skills and ability to collaborate with multiple departments

Responsibilities

• Work with 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.
• 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 reward programs, making recommendations for enhancements as needed.
• Resolve provider abrasion issues effectively, ensuring a positive and collaborative relationship between Humana and its providers.
• Implement strategies to minimize provider abrasion and enhance overall satisfaction.
• Partner with internal teams to track and report on market performance, ensuring alignment with organizational goals.
• Collaborate with cross-functional teams to drive initiatives that support provider performance improvement.
• Actively monitor and analyze provider performance data to identify areas for improvement.
• Implement strategies to enhance outcomes and provide ongoing support and guidance to providers.
• 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 internal teams to ensure seamless access to necessary resources and support.
• 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 as needed.

Benefits

• Medical benefits
• Dental benefits
• 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 disability
• Long-term disability
• Life insurance
• Bonus incentive plan
• Bi-weekly payment for internet expense (for employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota)

What This Job Offers

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