Become a part of our caring community
 

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 operate with a high degree of independence, often determining methods/approach to work and establishing own work priorities and timelines. Your work consists of tasks that are moderately complex, requiring minimal instructions to achieve solutions. You may provide coaching and/or review the work of lower-level associates. You will make decisions on moderately complex issues; exercise discretion and judgment over policies and own approach/priorities. Your 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.

Use your skills to make an impact
 

Required Qualifications

• Bachelor's degree in business, finance, health care/administration, nursing (BSN), or a related field, or equivalent work experience.

• Experience with Medicare Risk Adjustment and/or medical coding.

• Experience with Medicare and/or managed care.

• Understanding of NCQA HEDIS measures, PQA Measures, CMS Star Rating System, and CAHPS/HOS survey system.

• Ability to drive interoperability and understanding of Consumer/Patient Experience.

• Proven experience building relationships with physician groups and influencing execution of recommended strategies.

• Strong communication and presentation skills, both verbal and written, with experience presenting to internal and external customers, including high-level leadership.

• Focus on process and quality improvement, with an understanding of metrics, trends, and the ability to identify gaps in care.

• Comprehensive knowledge of Microsoft Office Word, Excel, and PowerPoint.

• Candidates must live in WA, OR, ID, WY, MT, UT, CA, NV, AZ, CO, or NM.

• Willingness to travel a minimum of 25% within region.

• Must be able to work during 8:00 a.m. – 5:00 p.m. Monday – Friday according to Pacific (PST) or Mountain (MST) time zones.

Additional Information

This is a remote position.

Work At Home / Internet Statement:

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