United States onlyBecome a part of our caring community and help us put health first
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. Operates with a high degree of independence, often determining methods/approach to work and establishing own work priorities and timelines. Work consists of tasks that are moderately complex, requiring minimal instructions to achieve solutions. May provide coaching and/or review the work of lower-level associates. Makes decisions on moderately complex issues; exercises discretion and judgment over policies and own approach/priorities. Work impacts the achievement of results for the department and begins to influence the department’s strategy.Key Responsibilities
- Provider Collaboration: Work with providers to define and advance their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies. Recommend execution strategies and monitor performance toward these goals.
- 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: Actively monitor and analyze provider performance data to identify areas for improvement. Implement strategies to enhance outcomes and provide ongoing support and guidance 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 internal teams to ensure seamless access to necessary resources and 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 as needed.
- Provider Abrasion Resolution: Resolve provider abrasion issues effectively, 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 internal teams to track and report on market performance, ensuring alignment with organizational goals. Collaborate with cross-functional teams to drive initiatives that support provider performance improvement.
In addition to the stated requirements for this role, you will also possess the following:
- Understanding of and ability to drive interoperability
- Understanding of Consumer/Patient Experience
- Strong communication and presentation skills, both verbal and written, and experience presenting to internal and external customers, including high-level leadership
- Understanding of metrics, trends and the ability to identify gaps in care
Use your skills to make an impact
Required Qualifications
- 2-5 years of experience with Medicare and/or managed care
- 2-5 years of experience working with 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
- Experience with focus on process and quality improvement
- Proven organizational and prioritization skills and ability to collaborate with multiple departments
- Comprehensive knowledge of all Microsoft Office Word, Excel and PowerPoint
- Must be able to work during 8am-5pm [Central]
- Must live in the State of Alabama
- Ability and willingness to travel up to 10% of the time
Preferred Qualifications
- RN or BSN (unrestricted compact license)
- Experience with Medicare Risk Adjustment and/or medical coding
- Progressive experience with interoperability solutions in healthcare
Additional Information
This role is "remote/work at home", however, you must be located within the Eastern Central region of Alabama to be considered for this opportunity.
Work at Home Information
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees 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 employees 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.
Scheduled Weekly Hours
40Pay Range
The 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 yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of 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 committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.
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.
