Senior Network Performance Professional

About the Role

Employment Type: Full time

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