Senior Network Performance Professional

Humana; United States; 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 deliver high-quality healthcare. You will work collaboratively with providers to improve their performance through strategic initiatives and education on the Stars/Quality program. Ideal candidates have a Bachelor's Degree in a relevant field, experience with Medicare, and strong communication skills. This role offers a competitive salary and benefits package.

Benefits

Medical, dental, and vision benefits

401(k) retirement savings plan

Paid time off and volunteer time off

Short-term and long-term disability

Life insurance

Qualifications

• Bachelor's Degree or equivalent work experience is required.
• Experience in Medicare or managed care is necessary.
• Ability to resolve provider abrasion issues is essential.

Responsibilities

• Work with providers on interoperability and value-based arrangements.
• Serve as an expert on the Stars/Quality program.
• Act as a liaison for providers to access Humana resources.

Skills

Experience with Medicare and/or managed care

Strong communication and presentation skills

Understanding of NCQA and CMS Stars Rating System

Experience building relationships with physician groups

Understanding of Consumer/Patient Experience

Understanding of metrics and trends

Proven organizational and prioritization skills

Education

Bachelor's Degree in Business, Finance, Health Care/Administration, RN or related field

Master’s Degree in Business, Finance, Health Care/Administration, RN or related field

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 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 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.
• 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.

Required Qualifications

• Bachelor's Degree in Business, Finance, Health Care/Administration, RN or a 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)

• Understanding of clinical utilization and levers to improve performance

• Understanding of and ability to drive interoperability

• Understanding of Consumer/Patient Experience

• Experience building relationships with physician groups and influencing execution of recommended strategy

• Strong communication and presentation skills, both verbal and written, and experience presenting to internal and external customers, including high-level leadership

• Experience with focus on process and quality improvement

• Understanding of metrics, trends and the ability to identify gaps in care

• Comprehensive knowledge of all Microsoft Office Word, Excel and PowerPoint

• Must be able to work during 8-5pm (Central Time Zone)

• Willingness to travel a minimum of 25% within region (Texas, Arkansas, or Oklahoma)

Preferred Qualifications

• Master’s Degree in Business, Finance, Health Care/Administration, RN or a related field

• Experience with Medicare Risk Adjustment and/or medical coding

• Proven organizational and prioritization skills and ability to collaborate with multiple departments

Additional Information

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 / Internet Guidance

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.

SSN Information

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from [e-mail] with instructions on how to add the information into your official application on Humana’s secure website.

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.