Senior Network Performance Professional

Humana

23h • Remote

About The Position

Become a part of our caring community 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. May provide coaching and/or review the work of lower-level associates. You will report to the Associate Director, Network Performance.

Requirements

• 3+ years' experience with Medicare and/or managed care
• Experience building relationships with physician groups and influencing execution of recommended strategy
• Experience with focus on process and quality improvement
• Proven organizational and prioritization skills and ability to collaborate with multiple departments
• In-depth experience in Microsoft Excel including formulas, pivots, charts, and graphs.
• Comprehensive knowledge of Microsoft Office Applications including Word and PowerPoint
• Must be able to work during 8am-5pm
• Ability and willingness to travel up to 10% of the time

Nice To Haves

• Bachelor's degree
• RN or BSN (unrestricted compact license)
• 5+ years' experience with Medicare and/or managed care
• Experience with Medicare Risk Adjustment and/or medical coding
• Progressive experience with interoperability solutions in healthcare
• 2+ years of experience working with NCQA HEDIS measures, PQA Measures, CMS Star Rating System and CAHPS/HOS survey system
• Experience with SQL including the ability to create reports from scratch and run existing reports
• Experience with tools such as Power BI, Power Apps, and/or Microsoft Access for running analysis, automating processes, or creating dashboards, self-service tools, and data visualizations
• Data analysis, experience with relational databases
• Live within region: Louisiana, Mississippi, Alabama, or Tennessee

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.
• 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.
• 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.

Benefits

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees