Provider Performance & Stars Strategy Lead

Visa Hunt; United States; Remote; USD 78,000 - 108,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k)

Job summary

Humana is seeking a Senior Network Performance Professional to drive provider collaboration and improve STARs ratings. You will educate physician groups on HEDIS, patient safety, and experience metrics, while coordinating with internal teams to track performance and implement improvement plans.

The role emphasizes relationship-building, engagement with payors and providers, and a focus on value-based care initiatives, with travel requirements and 40-hour weeks in the Central Time zone.

Qualifications

• Bachelor's Degree in Business, Finance, Health Care/Administration, RN or related field, or equivalent work experience
• Experience with Medicare and/or managed care
• Understanding of NCQA and CMS Stars Rating System (HEDIS measures, PQA Measures, and CAHPS/HOS survey system)
• Experience building relationships with physician groups and influencing execution of strategy
• Strong communication and presentation skills to internal and external customers

Responsibilities

• Define and advance providers' goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies
• Serve as an expert on the Stars/Quality program and educate physician groups on HEDIS, patient safety, and patient experience
• Resolve provider abrasion issues and maintain positive relationships
• Partner with internal teams to track and report market performance
• Monitor and analyze provider performance data to identify improvements
• Act as a liaison to access Humana resources and self-serve tools
• Educate provider groups on reward programs and target metrics, and monitor effectiveness

Skills

Relationship-building

Communication

Presentations

Data analysis

Interoperability

Education

Bachelor's Degree in Business/Health Admin or related

Tools

Microsoft Office

HEDIS tools

Job description

Humana is seeking a Senior Network Performance Professional to drive provider collaboration and improve STARs ratings. You will educate physician groups on HEDIS, patient safety, and experience metrics, while coordinating with internal teams to track performance and implement improvement plans.

The role emphasizes relationship-building, engagement with payors and providers, and a focus on value-based care initiatives, with travel requirements and 40-hour weeks in the Central Time zone.