Humana

Senior Network Performance Professional

Texas, United States

Not SpecifiedCompensation
Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries

Requirements

Candidates must possess a Bachelor's degree in Business, Finance, Health Care/Administration, RN, or a related field, or equivalent work experience. Required qualifications include experience with Medicare and/or managed care, a strong understanding of the NCQA and CMS Stars Rating System (including HEDIS measures, PQA Measures, and CAHPS/HOS survey system), knowledge of clinical utilization and performance improvement levers, and the ability to drive interoperability. Experience in building relationships and understanding consumer/patient experience is also necessary.

Responsibilities

The Senior Network Performance Professional will collaborate with providers to define and advance goals in interoperability, quality, value-based arrangements, and risk adjustment strategies, recommending and monitoring execution plans. They will serve as an expert on the Stars/Quality program, educating physician groups on HEDIS, patient safety, and patient experience, and developing tailored action plans. Responsibilities include resolving provider abrasion issues to maintain positive relationships, partnering with internal teams to track and report market performance, and analyzing provider data to identify and implement performance improvement strategies. Additionally, they will act as a liaison for providers to access Humana resources, educate provider groups on reward programs and target metrics, and monitor the effectiveness of these programs.

Skills

Network Performance
Provider Relations
STARs ratings
HEDIS
Quality Programs
Value-based arrangements
Risk adjustment
Interoperability
Healthcare
Action Planning
Performance Monitoring
Problem-Solving
Communication

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

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.
Rising medical costs and tightening Medicare reimbursements may strain financial performance.
Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.
The company emphasizes inclusivity, offering free language interpreter services for accessibility.
Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.
The company is the first insurer to cover TMS therapy for adolescent depression.
Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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