[Remote] Senior Network Performance Professional at Humana

Texas, United States

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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 have equivalent work experience. A strong understanding of Medicare and/or managed care, the NCQA and CMS Stars Rating System (including HEDIS measures, PQA Measures, and CAHPS/HOS survey system), clinical utilization, and levers for performance improvement is required. Additionally, candidates need knowledge of interoperability and consumer/patient experience, along with proven experience in building relationships.

Responsibilities

The Senior Network Performance Professional will collaborate with providers to define and advance goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies, recommending execution strategies and monitoring performance. They will serve as an expert on the Stars/Quality program, educating physician groups and developing tailored action plans to improve performance reward programs. This role involves resolving provider abrasion issues, partnering with internal teams to track market performance, and analyzing provider data to identify and implement performance improvement strategies. The professional will also act as a liaison for providers to access Humana resources and educate them on self-serve tools.

Skills

Network Performance

Provider Relations

STARs ratings

HEDIS

Quality Programs

Risk Adjustment

Interoperability

Value-Based Care

Relationship Building

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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