Senior Network Performance Professional

Humana • Oklahoma City, TX

1d • $78,400 - $107,800 • Remote

About The Position

As a Senior Network Performance Professional at Humana, you will work with providers to improve their Stars ratings and overall performance through strategic initiatives and relationship-building. The role supports Humana’s mission to deliver high-quality healthcare and offers the opportunity to use healthcare provider-relations expertise to influence operational decisions and organizational success.

The position operates with a high degree of independence. Work involves moderately complex tasks requiring minimal instruction, and the role may include coaching or reviewing the work of lower-level associates. The position makes decisions on moderately complex issues, exercises discretion over policies and work priorities, impacts departmental results, and begins to influence department strategy. You will report to the Manager, Network Performance.

This is a remote/work-at-home role for someone living in Texas, Oklahoma, or Arkansas, with a willingness to travel at least 25%. The schedule is 8 a.m.–5 p.m. Central Time, 40 hours per week. The planned start date is January 4, 2027. Work-at-home employees must have internet service with at least 25 Mbps download and 10 Mbps upload speeds and work from a dedicated space that protects member PHI/HIPAA information. Occasional travel to Humana offices for training or meetings may be required.

Requirements

• Bachelor’s degree.
• At least 2 years of experience working with Medicare and/or managed care.
• Working knowledge of NCQA and the CMS Stars Rating System, including HEDIS measures, PQA measures, and CAHPS/HOS survey systems.
• Understanding of clinical utilization and levers for improving performance.
• Understanding of and ability to drive interoperability.
• Understanding of consumer/patient experience.
• Experience building relationships with physician groups and influencing execution of recommended strategies.
• Experience focused on process and quality improvement.
• Understanding of metrics and trends, with the ability to identify gaps in care.
• Ability to work 8 a.m.–5 p.m. Central Time.
• Must live in Texas, Arkansas, or Oklahoma and be willing to travel a minimum of 25%.
• For remote work, self-provided internet service must provide at least 25 Mbps download and 10 Mbps upload; a dedicated work area must protect member PHI/HIPAA information.

Nice To Haves

• Master’s degree.
• Experience with Medicare Risk Adjustment and/or medical coding.
• Proven organizational and prioritization skills and ability to collaborate with multiple departments.

Responsibilities

• Work with providers to define and advance goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies; recommend execution strategies and monitor progress.
• Serve as an expert on the Stars/Quality program and educate physician groups on HEDIS, patient safety, and patient experience.
• Collaborate with providers to develop tailored action plans and communicate actionable insights to improve performance reward programs; recommend enhancements as needed.
• Resolve provider abrasion issues and implement strategies to minimize abrasion and improve provider satisfaction.
• Partner with internal teams to track and report market performance and ensure alignment with organizational goals.
• Collaborate with cross-functional teams on initiatives that support provider performance improvement.
• Monitor and analyze provider performance data to identify improvement opportunities; implement strategies and provide ongoing guidance and support.
• Help providers access Humana resources by educating them about and encouraging use of self-service tools; facilitate communication with internal teams.
• Educate provider groups on reward programs and target metrics, collaborate to achieve goals, and monitor and report program effectiveness.
• Coach and/or review the work of lower-level associates, as needed.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, company holidays, and personal holidays.
• Paid parental and caregiver leave.
• Short-term and long-term disability coverage.
• Life insurance.
• Bonus incentive plan based on company and/or individual performance.
• Other opportunities and benefits supporting personal wellness and healthcare decisions.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior