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

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
• Must be able to work during 8-5pm [Eastern]
• Willingness to travel a minimum of 10%
• Must live/work within the region (North Carolina or South Carolina)

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

This role is "remote/work at home", however, you must live within the region (North Carolina or South Carolina)

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.

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

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 ba