Job Description
Senior Network Performance Professional / Consultant Become a part of our caring community. As a Senior Network Performance Professional / Consultant at Humana, you will help 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 relationship building. You will report to the Manager, Network Performance.
Responsibilities Provider Collaboration: Work with providers to define and improve their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies.
Stars/Quality Program Expertise: 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.
Performance Improvement: Monitor and analyze provider performance data to identify areas for improvement. Implement strategies to enhance outcomes and provide ongoing support to providers.
Resource Liaison: 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 our teams to ensure seamless access to necessary support.
Reward Programs: 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.
Provider Abrasion Resolution: 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.
Internal Collaboration: Partner with our teams to track and report market performance, ensuring alignment with organizational goals.
Required Qualifications 2 or more years of experience with Medicare or managed care.
Live in CST or EST and work during 8am-5pm CST or EST.
3 or more years of NCQA HEDIS measures, PQA Measures, CMS Star Rating System and CAHPS/HOS survey system.
- or more years of understanding of Consumer / Patient Experience.
- or more years of experience building relationships with physician groups and influencing execution of recommended strategy.
1 or more years of experience with focus on process and quality improvement.
Comprehensive knowledge of all Microsoft Word, Excel and PowerPoint.
Preferred Qualifications Bachelor's Degree.
Lives in the region IN, KY, MI, OH, WV.
Experience presenting to internal and external customers, including high-level leadership.
Progressive experience with interoperability solutions in Healthcare.
Experience with Medicare Risk Adjustment and/or medical coding.
Understanding of metrics, trends and the ability to identify gaps in care.
1 or more years' experience with tools such as Power BI, Tableau, Qlikview.
Additional Information You will work remote and this role have at least 10% of travel.
Hiring Process As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Work at Home Guidance At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours 40
Pay Range $78,400 – $107,800 per year. This job is eligible for a bonus incentive plan.
Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and 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 and many other opportunities.
About Us 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. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer 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.
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Job Tags
Bi-weekly pay, Temporary work, Apprenticeship, Live in, Work from home, Home office