Become 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 within the SouthEast Region 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.

Key Responsibilities

• Works with SouthEast Region providers to define and advance their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies
• Recommends execution strategies and monitor performance toward these goals
• Actively monitors and analyzes provider performance data to identify areas for improvement
• Serves as an expert on the Stars/Quality program, educating physician groups on HEDIS, patient safety, and patient experience
• Collaborates to develop tailored action plans and communicate actionable insights to improve performance
• Implements strategies to enhance outcomes and provide ongoing support and guidance to providers
• Acts as a liaison for providers to access Humana resources, educating and encouraging providers on the use of self-serve tools
• Facilitates communication between providers and internal teams to ensure seamless access to necessary resources and support
• Educates provider groups on reward programs and target metrics, collaborating to achieve established goals
• Monitors and reports on the effectiveness of reward programs, making recommendations for enhancements as needed
• Resolves provider abrasion issues effectively, ensuring a positive and collaborative relationship between Humana and its providers
• Implements strategies to minimize provider abrasion and enhance overall satisfaction
• Partners with internal teams to track and report on market performance, ensuring alignment with organizational goals
• Collaborates with cross-functional teams to drive initiatives that support provider performance improvement

In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:

• Medical Benefits
• Dental Benefits
• Vision Benefits
• Health Savings Accounts
• Flex Spending Accounts
• Life Insurance
• 401(k)
• PTO including 9 paid holidays, one personal holiday, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time
• And more

Use your skills to make an impact
 

Required Qualifications

• 3+ years experience with Medicare and/or managed care
• 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
• Comprehensive knowledge of all Microsoft Office Word, Excel and PowerPoint
• Experience presenting to internal and external customers, including high-level leadership
• Strong communication skills, both verbal and written
• Must be able to work during 8-5pm [Eastern]
• Willingness to travel a minimum of 10%

Preferred Qualifications

• Bachelor's Degree or Master’s Degree in Business, Finance, Health Care/Administration, RN or a related field
• Experience with Medicare Risk Adjustment
• Progressive experience with interoperability solutions in Healthcare
• Proven organizational and prioritization skills and ability to collaborate with multiple departments

Additional Information

Work at Home/Remote Requirements

Work-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 recommended to support Humana applications, per associate.
  • Wireless, Wired Cable or DSL connection is suggested.
  • Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership.  (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.)
  • Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exception of associates who live or work from Home in the state of California, Illinois, Montana, or South Dako