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 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. You will report to the Manager, Network Performance.
Requirements
- 4+ years' experience with Medicare Advantage
- 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
- Understanding of Consumer/Patient Experience
- Understanding of metrics, trends and the ability to identify gaps in care
- Understanding of and ability to drive interoperability
- Experience presenting to internal and external customers, including high-level leadership
- Experience with focus on process and quality improvement
- Comprehensive knowledge of all Microsoft Office Word, Excel and PowerPoint
- Must be able to work during 8-5pm EST
Nice To Haves
- Experience with Medicare Risk Adjustment and/or medical coding
- Progressive experience with interoperability solutions in Healthcare
- Bachelor's Degree in Business, Finance, Health Care/Administration, RN or a related field
Responsibilities
- Recommend execution strategies to providers to advance their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies
- Serve as an expert on the Stars/Quality program, educating physician groups on HEDIS, patient safety, and patient experience
- Actively monitor and analyze provider performance data to identify areas for improvement
- 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 and monitor effectiveness of reward programs, collaborating to achieve established goals
- Resolve provider abrasion issues effectively, ensuring a positive and collaborative relationship between Humana and its providers
- Partner with internal and cross-functional teams to track and report on market performance, ensuring alignment with organizational goals
Benefits
- Health benefits effective day 1
- Paid time off, holidays, volunteer time and jury duty pay
- Recognition pay
- 401(k) retirement savings plan with employer match
- Tuition assistance
- Scholarships for eligible dependents
- Parental and caregiver leave
- Employee charity matching program
- Network Resource Groups (NRGs)
- Career development opportunities
- medical, dental and vision benefits
- 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
