Senior Network Performance Professional

Humana

1d • 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 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

• 4+ years' experience with Medicare and/or managed care
• 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
• Must be able to work during 8-5pm [Eastern]
• Willingness to travel a minimum of 10%
• Must be located within the Southeast region

Nice To Haves

• Bachelor's Degree or Master's 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

• Works with Southeast Region providers to define and advance their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies
• Recommends execution strategies and monitor performance toward these goals
• Actively monitors and analyzes provider performance data to identify areas for improvement
• Serves as an expert on the Stars/Quality program, educating physician groups on HEDIS, patient safety, and patient experience
• Collaborates to develop tailored action plans and communicate actionable insights to improve performance
• Implements 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
• Facilitates communication between providers and internal teams to ensure seamless access to necessary resources and support
• Educates provider groups on reward programs and target metrics, collaborating to achieve established goals
• Monitors and reports on the effectiveness of reward programs, making recommendations for enhancements as needed
• Resolves provider abrasion issues effectively, ensuring a positive and collaborative relationship between Humana and its providers
• Implements strategies to minimize provider abrasion and enhance overall satisfaction
• Partners with internal teams to track and report on market performance, ensuring alignment with organizational goals
• Collaborates with cross-functional teams to drive initiatives that support provider performance improvement

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

What This Job Offers

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