[Remote] Senior Network Performance Professional at Humana

Utah, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

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

Responsibilities

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
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
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
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
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
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
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

Skills

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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