Senior Network Performance Professional

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

Job summary

A leading health insurance company is seeking a Senior Network Performance Professional to enhance provider performance and improve STARs ratings. The role involves collaborating with providers, monitoring performance, and providing strategic insights to improve health outcomes. Ideal candidates will possess a bachelor's degree and strong communication skills. Offering competitive benefits and a pay range of $78,400 - $107,800 per year.

Benefits

Medical, dental, and vision insurance

401(k) retirement savings

Paid time off and holidays

Qualifications

• Experience with Medicare Risk Adjustment and/or medical coding.
• Strong communication and presentation skills, both verbal and written.
• Ability to drive interoperability and understanding of Consumer/Patient Experience.

Responsibilities

• Work with providers to define and advance goals related to interoperability and quality.
• Serve as an expert on the Stars/Quality program.
• Act as a liaison for providers to access Humana resources.

Skills

Communication skills

Relationship building

Data analysis

Process improvement

Education

Bachelor's degree in business, finance, health care/administration, nursing, or a related field

Tools

Microsoft Office (Word, Excel, PowerPoint)

Job description

Overview

Senior Network Performance Professional at Humana to enhance provider performance, improve STARs ratings, and advance Humana's mission to deliver high-quality healthcare. Works with providers to influence operational decisions and support organizational success. Operates with independence, setting own work priorities and timelines. Roles may include coaching and reviewing work of lower-level associates. Makes decisions on moderately complex issues and influences department strategy.

Key Responsibilities

• Provider Collaboration: Work with providers to define and advance 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 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 a 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

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 offers competitive benefits that support whole-person well-being. Benefits include medical, dental and vision, 401(k) retirement savings, paid time off and holidays, volunteer time off, parental and caregiver leave, short-term and long-term disability, life insurance, and more.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first for teammates, customers and the company. Through Humana insurance services and CenterWell healthcare services, we help millions achieve their best health, delivering care and service when needed for Medicare, Medicaid, families, individuals, military personnel, and communities at large.

Equal Opportunity Employer

Humana does not discriminate against any employee or applicant and is an equal opportunity employer. Humana also affirms compliance with Section 503 and VEVRAA to recruit and advance individuals with disabilities and protected veterans where qualified. Employment decisions are based on valid job requirements and do not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status.