[Remote] Senior Network Performance Professional at Humana

North Carolina, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

3+ years' experience with Medicare and/or managed care
Understanding of NCQA HEDIS measures, PQA Measures, CMS Star Rating System and CAHPS/HOS survey system
Experience building relationships with physician groups and influencing execution of recommended strategy
Comprehensive knowledge of all Microsoft Office Word, Excel and PowerPoint
Experience presenting to internal and external customers, including high-level leadership
Must be able to work during 8-5pm Eastern
Willingness to travel a minimum of 10%
Must live/work within the region (North Carolina or South Carolina)

Responsibilities

Works with SouthEast Region providers to define and advance their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies
Recommends execution strategies and monitor performance toward these goals
Actively monitors and analyzes provider performance data to identify areas for improvement
Serves as an expert on the Stars/Quality program, educating physician groups on HEDIS, patient safety, and patient experience
Collaborates to develop tailored action plans and communicate actionable insights to improve performance
Implements strategies to enhance outcomes and provide ongoing support and guidance to providers
Acts as a liaison for providers to access Humana resources, educating and encouraging providers on the use of self-serve tools
Facilitates communication between providers and internal teams to ensure seamless access to necessary resources and support
Educates provider groups on reward programs and target metrics, collaborating to achieve established goals
Monitors and reports on the effectiveness of reward programs, making recommendations for enhancements as needed
Resolves provider abrasion issues effectively, ensuring a positive and collaborative relationship between Humana and its providers
Implements strategies to minimize provider abrasion and enhance overall satisfaction
Partners with internal teams to track and report on market performance, ensuring alignment with organizational goals
Collaborates with cross-functional teams to drive initiatives that support provider performance improvement

Skills

Key technologies and capabilities for this role

HEDISSTARsRisk AdjustmentValue-Based CareInteroperabilityProvider RelationsPerformance AnalysisQuality ImprovementData MonitoringAction Planning

Questions & Answers

Common questions about this position

What are the required qualifications for this Senior Network Performance Professional role?

Candidates need 3+ years' experience with Medicare and/or managed care, understanding of NCQA HEDIS measures, PQA Measures, CMS Star Rating System and CAHPS/HOS survey system, experience building relationships with physician groups, comprehensive knowledge of Microsoft Office (Word, Excel, PowerPoint), and experience presenting to internal and external customers including high-level leadership.

Is this position remote or does it require a specific location?

You must live/work within the SouthEast Region, specifically North Carolina or South Carolina, and be able to work during 8-5pm Eastern time with a minimum of 10% travel.

What is the salary or compensation for this role?

This information is not specified in the job description.

What preferred qualifications will make my application stronger?

A Bachelor’s Degree or Master’s degree in business, Finance, Health Care/Administration, RN or a related field, experience with Medicare Risk Adjustment, progressive experience with interoperability solutions in Healthcare, and proven organizational and prioritization skills with ability to collaborate with multi-disciplinary teams are preferred.

What is the work schedule and travel requirement for this position?

The role requires working during 8-5pm Eastern time with a willingness to travel a minimum of 10%.

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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