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.
Key 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
Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including:
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
Required Qualifications- 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
- Travel up to 10%
Preferred Qualifications- 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
Additional InformationWork-At-Home Requirements- To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
- Satellite, cellular and microwave connection can be used only if approved by leadership.
- Employees 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
Our Hiring ProcessAs part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected, you will receive correspondence inviting you to participate in a HireVue assessment. You will have a set of questions and you will provide responses to each question. You should anticipate this to take about 10-15 minutes. Your answers will be reviewed, and you will subsequently be informed if you will be moving forward to next round.
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Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours40
Pay RangeThe compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$78,400 - $107,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of BenefitsHumana, 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.
