Remote Senior Network Performance & Stars Quality Strategist

Humana; Arkansas; Remote; USD 78.000 - 108.000; Vollzeit

Benefits dieser Stelle

Bonus incentive plan

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Zusammenfassung

Humana seeks a Senior Network Performance Professional to enhance provider performance, improve STARs ratings, and drive strategic initiatives with physician groups. The role emphasizes independent decision-making, relationship-building, and cross-functional collaboration across Humana's networks.

The position reports to the Manager, Network Performance, with a remote/work-at-home setup within the region and occasional travel.

Qualifikationen

• Bachelor's degree required.
• 2+ years of Medicare/managed care experience.
• Knowledge of NCQA and CMS Stars Rating System.
• Understanding of clinical utilization and improvement levers.
• Understanding of interoperability and patient experience.
• Experience building physician group relationships and influencing strategy.
• Strong focus on process and quality improvement.
• Ability to analyze metrics and identify care gaps.
• Must be able to work 8am–5pm CT and travel up to 25% within the region.

Aufgaben

• Provider Collaboration: define and advance goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies.
• Stars/Quality Program Expertise: educate physician groups on HEDIS, patient safety and patient experience; develop tailored action plans.
• Provider Abrasion Resolution: resolve abrasion issues and improve provider relations.
• Internal Collaboration: track and report market performance with internal teams.
• Performance Improvement: monitor provider performance data and implement improvement strategies.
• Resource Liaison: educate providers on self-serve tools and access Humana resources.
• Reward Programs: educate groups on rewards and target metrics; monitor program effectiveness.

Kenntnisse

Provider relations

Interoperability

Quality improvement

Patient experience

Data analysis

Ausbildung

Bachelor's Degree

Master's Degree

Jobbeschreibung

Humana seeks a Senior Network Performance Professional to enhance provider performance, improve STARs ratings, and drive strategic initiatives with physician groups. The role emphasizes independent decision-making, relationship-building, and cross-functional collaboration across Humana's networks.

The position reports to the Manager, Network Performance, with a remote/work-at-home setup within the region and occasional travel.