Senior Network Performance Professional
About The Position
Become a part of our caring community As a Senior Network Performance Professional 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 programs and relationship-building. You will have a unique opportunity to use your expertise in healthcare provider relations to influence operational decisions and support the success of the organization. Operate 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 review the work of lower-level associates. You will make decisions on moderately complex issues; 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
- 5+ years of healthcare experience
- 3+ years of experience with Medicare and/or managed care
- Understanding of NCQA HEDIS measures, Patient Safety Measures, CMS Star Rating System and CAHPS/HOS survey system
- 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
- Must live in the state of Alabama
- Must be able to work 8am-5pm
- Willingness to travel a minimum of 10% within the region
Nice To Haves
- Understanding of interoperability
- Understanding of Consumer/Patient Experience
- Strong communication and presentation skills, both verbal and written, and experience presenting to internal and external customers, including high-level leadership
- Understanding of metrics, trends, and the ability to identify gaps in care
- Organizational and prioritization skills and ability to collaborate with multiple departments
- Bachelor’s Degree, RN or BSN (unrestricted compact license), or equivalent healthcare experience
- Experience with Medicare Risk Adjustment and/or medical coding
- Progressive experience with interoperability solutions in healthcare
Responsibilities
- Work with providers to define and improve their goals related to interoperability, quality-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.
- Monitor provider performance data to identify areas for improvement. Implement strategies to enhance outcomes and provide ongoing support 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 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.
- 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.
- Partner with internal teams to report on market performance, ensuring alignment with organizational goals. Collaborate with cross-functional teams to lead programs that support provider performance improvement.
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
