Senior Network Performance Professional
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 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 a Senior Network Performance Professional 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.
Requirements
- Must be located and reside within the Southeast region
- Minimum 4 years of experience with Medicare and/or managed care
- Knowledge/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
- Willingness to travel a minimum of 10%
- At minimum, a download speed of 25 mbps and an upload speed of 10 mbps is recommended; wireless, wired cable or DSL connection is suggested
- Satellite, cellular and microwave connection can be used only if approved by leadership
- Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Nice To Haves
- Advanced degree in business, Finance, Health Care/Administration, RN or a related field
- Experience with Medicare Risk Adjustment
- Progressive experience with interoperability solutions in healthcare
- Proven organizational and prioritization skills and ability to collaborate with multiple departments
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
- 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
- Implement strategies to enhance outcomes and provide ongoing support and guidance to providers
- Acts 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
- Use your skills to make an impact
Benefits
- medical
- dental
- 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
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Associate degree
