[Remote] Senior Network Performance Professional at Humana

Washington, District of Columbia, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

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 or OR
Willingness to travel a minimum of 25% within region
Must be able to work during 8:00 a.m. – 5:00 p.m

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
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
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

Skills

Key technologies and capabilities for this role

HEDISStars/Quality ProgramRisk AdjustmentValue-Based ArrangementsInteroperabilityProvider RelationsPerformance AnalysisPatient SafetyPatient Experience

Questions & Answers

Common questions about this position

What is the employment type for this Senior Network Performance Professional role?

This is a full-time position.

Is this role remote or does it require office presence?

This information is not specified in the job description.

What are the required qualifications for this position?

A Bachelor’s degree in business, finance, or a related field is required.

What is the work environment like at Humana for this role?

The role operates with a high degree of independence, determining methods/approach to work, establishing own priorities and timelines, and may involve coaching lower-level associates.

What experience makes a strong candidate for this Senior Network Performance Professional role?

Strong candidates will have expertise in healthcare provider relations, Stars/Quality programs including HEDIS, and skills in performance improvement, data analysis, and relationship-building with providers.

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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