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About the Role
As a Senior Network Performance Professional at Humana, you will enhance provider performance and advance 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, leveraging your expertise to influence operational decisions.
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
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
Skills
- Medicare Advantage
- NCQA HEDIS measures
- PQA Measures
- CMS Star Rating System
- CAHPS/HOS survey system
- Relationship building
- Strategy influence
- Consumer/Patient Experience
- Metrics analysis
- Gap analysis
- Interoperability
- Presentation skills
- Process improvement
- Quality improvement
- Microsoft Office Suite (Word, Excel, PowerPoint)
- Medicare Risk Adjustment
- Medical coding
- Interoperability solutions in Healthcare
Location
- Remote
Work Type
- Full-time
- Remote
Experience Level
- Senior
Education Level
- Bachelor's Degree in Business, Finance, Health Care/Administration, RN or a related field
Salary/Compensations
- $78,400 - $107,800 per year
Benefits
- Health benefits effective day 1
- Paid time off
- Holidays
- Volunteer time
- 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 benefits
- Dental benefits
- Vision benefits
- Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
- Short-term disability
- Long-term disability
- Life insurance
About the Company
- Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity
- It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status.
- It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements.
- This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.