Senior Network Performance Professional

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

Job summary

A leading healthcare organization is seeking a Senior Network Performance Professional to enhance provider performance and advance healthcare quality. The role involves collaboration with providers, performance improvement, and leveraging expertise in Medicare and quality programs. An ideal candidate will have strong relationships with physician groups and excellent communication skills, with a focus on data analysis and process improvement. A bachelor's degree and experience with Medicare is required.

Benefits

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off

Qualifications

• Experience with Medicare Risk Adjustment and/or medical coding.
• Understanding of NCQA HEDIS measures and CMS Star Rating System.
• Proven experience building relationships with physician groups.

Responsibilities

• Work with providers to define and advance their goals related to interoperability.
• Educate physician groups on HEDIS and patient experience.
• Actively monitor and analyze provider performance data.

Skills

Relationship Building

Communication Skills

Data Analysis

Process Improvement

Interoperability

Education

Bachelor’s degree in business, finance, health care/administration, nursing (BSN) or related field

Tools

Microsoft Office Word

Microsoft Office Excel

Microsoft Office PowerPoint

Job description

Overview

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

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. Operates with a high degree of independence, often determining methods/approach to work and establishing own work priorities and timelines. Work consists of tasks that are moderately complex, requiring minimal instructions to achieve solutions. May provide coaching and/or review the work of lower-level associates. Makes decisions on moderately complex issues; exercises discretion and judgment over policies and own approach/priorities. 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 improvement.

Use your skills to make an impact

Required Qualifications

• Bachelor’s degree in business, finance, health care/administration, nursing (BSN), or 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, UT, ID, OR, or MT.
• 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 and/or Mountain time zones.

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

$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.