Senior Network Performance Consultant

Humana Inc; Remote; USD 78,000 - 108,000; Full time

Job summary

A healthcare services company seeks a Senior Network Performance Professional in Raleigh, NC. You will improve provider performance in the SouthEast Region by enhancing STARs ratings through strategic initiatives and fostering relationships. Responsibilities include analyzing performance data, educating providers on healthcare measures, and executing performance strategies. Requires 5+ years of experience with Medicare and strong relationship-building skills. This remote role involves occasional travel and offers competitive benefits and compensation between $78,400 and $107,800 annually.

Benefits

Medical, dental, and vision benefits

401(k) retirement savings plan

Paid time off

Short-term and long-term disability

Qualifications

• 5 or more years' experience with Medicare and/or managed care.
• Understanding of NCQA HEDIS measures and CMS Star Rating System.
• Experience building relationships with physician groups.

Responsibilities

• Define and advance goals related to interoperability and quality.
• Monitor and analyze provider performance data.
• Educate physician groups on HEDIS and patient safety.

Skills

Relationship building

Data analysis

Presentation skills

Knowledge of NCQA HEDIS measures

Education

Bachelor's Degree

Tools

Microsoft Office (Word, Excel, PowerPoint)

Job description

Become a part of our caring community and help us put health first

As a Senior Network Performance Professional / Consultant 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. You will report to the Manager, Network Performance.

Responsibilities

• Work with SouthEast Region 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
• Actively monitor and analyze provider performance data to identify areas for improvement
• Be 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 applicable insights to improve performance
• Implement strategies to enhance outcomes and provide ongoing support and guidance to providers
• Be a liaison for providers to access Humana resources, educating and encouraging providers on the use of self-serve tools
• Educate provider groups on reward programs and target metrics, collaborating to achieve established goals
• Monitor and reports on the effectiveness of reward programs, making recommendations for enhancements
• Resolve provider abrasion issues, ensuring a positive and collaborative relationship between Humana and its providers
• Collaborate with teams to drive initiatives that support provider performance improvement

Use your skills to make an impact

Required Qualifications

• Live in NC, SC, GA or VA
• 5 or more 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
• Work hours 8am-5pm EST
• This role is a work at home role with Travel a minimum of 10%

Preferred Qualifications

• Bachelor's Degree
• Experience with Medicare Risk Adjustment
• Progressive experience with interoperability solutions in Healthcare

Additional Information

HireVue

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Work at Home

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.

#LI-BB1

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 based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$78,400 - $107,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our accessibility resources.