Provider Network Manager
Devoted HealthSalary not specified
- Full Time
- Junior (1 to 2 years)
Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries
Requirements
Candidates should possess a Bachelor’s degree in Business, Finance, Healthcare, or a related field, or equivalent experience, and prior Medicare experience with a strong understanding of value-based care. They must have knowledge of HEDIS/Stars and CMS quality measures, along with proficiency in analyzing and interpreting healthcare data and trends. Demonstrated capability with leading, coaching, and developing associates is also required, along with strong communication and presentation skills, including experience presenting to internal and external customers. A focus on process and quality improvement, with an understanding of metrics, trends, and the ability to identify gaps in care, is essential.
Responsibilities
As the Manager of Network Performance, the individual will lead a team of Network Performance Professionals, guiding them in their efforts to improve provider performance and enhance Stars ratings. They will serve as the expert on CMS Stars program, HEDIS, CAHPS, and HOS, providing guidance and support. The role involves building and maintaining strong relationships with provider practices, leading discussions to find and implement improvement opportunities, and monitoring outcomes. They will also inform the team based on enterprise, regional, and departmental KPIs and OKRs, ensuring alignment with organizational goals. Furthermore, they will partner with other departments to advance performance in various areas, analyze data to inform the team and leadership, create data-supported education, and own decisions related to people leadership, resources, strategic planning, and tactical operations for the team.
Skills
Healthcare provider relations
CMS Stars program
HEDIS
CAHPS
HOS
Provider engagement
Performance metrics
Cross-departmental collaboration
Data analysis
Team leadership
Workflow development
Humana
Health insurance provider for seniors and military
About Humana
Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.
Louisville, KentuckyHeadquarters
1961Year Founded
IPOCompany Stage
Social Impact, HealthcareIndustries
10,001+Employees