Senior Healthcare Network Consultant

Humana; Georgia; Hybrid; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare organization is seeking a professional to collaborate with providers to improve healthcare quality and interoperability. The ideal candidate will have extensive experience with Medicare, NCQA HEDIS measures, and strong communication skills. This position offers a competitive salary, comprehensive benefits, and flexible work-from-home arrangements. Candidates with a Bachelor's Degree and experience in the healthcare sector will stand out. Join us to enhance healthcare quality and support positive patient experiences.

Benefits

Salary up to $107,800 per year

Eligible for a bonus incentive plan

Comprehensive benefits package

Opportunity for career advancement

Flexible work-from-home arrangement

Qualifications

• 2+ years of experience with Medicare and/or managed care.
• 3+ years of experience with NCQA HEDIS measures and CMS Star Rating System.
• Strong understanding of Consumer/Patient Experience.

Responsibilities

• Collaborate with providers to advance their goals related to interoperability.
• Serve as an expert on the Stars/Quality program for physician groups.
• Monitor and analyze provider performance to identify areas for improvement.

Skills

Experience with Medicare and managed care

Knowledge of NCQA HEDIS measures

Strong communication skills

Proficiency in Microsoft Word, Excel, PowerPoint

Education

Bachelor's Degree

Job description

Employer Industry: Healthcare Services

Why consider this job opportunity:

• Salary up to $107,800 per year
• Eligible for a bonus incentive plan based on company and individual performance
• Comprehensive benefits package including medical, dental, vision, 401(k), paid time off, and more
• Opportunity for career advancement and growth within the organization
• Flexible work-from-home arrangement with occasional travel to company offices
• Supportive and collaborative work environment focused on improving healthcare quality

What to Expect (Job Responsibilities)

• Collaborate with providers to define and advance their goals related to interoperability and quality improvement
• Serve as an expert on the Stars/Quality program, educating physician groups on HEDIS and patient safety
• Monitor and analyze provider performance data to identify areas for improvement and implement strategies
• Act as a liaison for providers to access resources and facilitate communication with internal teams
• Resolve provider abrasion issues to ensure positive relationships and enhance overall satisfaction

What is Required (Qualifications)

• 2 or more years of experience with Medicare and/or managed care
• 3 or more years of experience with NCQA HEDIS measures and CMS Star Rating System
• 1 or more years of experience understanding Consumer/Patient Experience
• 2 or more years of experience building relationships with physician groups
• Comprehensive knowledge of Microsoft Word, Excel, and PowerPoint

How to Stand Out (Preferred Qualifications)

• Strong communication and presentation skills, with experience presenting to leadership
• Bachelor's Degree and understanding of interoperability in healthcare
• Progressive experience with interoperability solutions
• Experience with Medicare Risk Adjustment and/or medical coding
• Knowledge of metrics and trends to identify gaps in care

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