Senior Network Performance Professional

🕒 2 dias atrás

🌪️ Oklahoma, Texas – Remoto

🌪️ Oklahoma – Remote 🤠 Texas – Remote

💵 $78.400 - $107.800 / ano

⏰ Tempo Integral

🟠 Sênior

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Humana

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 1961

🏥 Saúde

🛡️ Seguros

⚕️ Seguro de Saúde

Healthcare • Insurance • Healthcare Insurance

A Humana é uma empresa de saúde dedicada a gerar um impacto positivo na saúde de indivíduos, comunidades e do sistema de saúde como um todo. Com foco em colocar a saúde em primeiro lugar, a Humana atende a uma ampla e diversa gama de populações, incluindo idosos e militares, oferecendo planos Medicare Advantage (HMO, PPO e PFFS). A Humana está comprometida em promover uma cultura de pertencimento e respeito mútuo, oferecendo benefícios competitivos e flexíveis para garantir a segurança financeira de seus funcionários e de suas famílias. A empresa se orgulha de criar um ambiente de trabalho inclusivo, no qual todos têm a oportunidade de ter sucesso.

Descrição

• Work with providers to define and advance goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies • Recommend execution strategies and monitor performance toward provider goals • Serve as an expert on the Stars/Quality program and educate physician groups on HEDIS, patient safety, and patient experience • Develop tailored action plans and communicate actionable insights to improve performance reward programs • Resolve provider abrasion issues and implement strategies to enhance provider satisfaction • Partner with internal teams to track and report market performance • Collaborate with cross-functional teams on provider performance improvement initiatives • Monitor and analyze provider performance data to identify improvement areas • Implement performance-enhancement strategies and provide ongoing provider support and guidance • Liaise with providers to facilitate access to Humana resources and self-serve tools • Educate provider groups on reward programs and target metrics • Monitor and report reward-program effectiveness and recommend enhancements • Report to the Manager, Network Performance

🎯 Requisitos

• Bachelor's Degree in Business, Finance, Health Care/Administration, RN, or a related field, or equivalent work experience • Experience with Medicare and/or managed care • Understanding of NCQA and CMS Stars Rating System, including HEDIS measures, PQA Measures, and CAHPS/HOS survey system • Understanding of clinical utilization and performance-improvement levers • Understanding of and ability to drive interoperability • Understanding of consumer/patient experience • Experience building relationships with physician groups and influencing execution of recommended strategy • Strong verbal and written communication and presentation skills • Experience presenting to internal and external customers, including high-level leadership • Experience with process and quality improvement • Understanding of metrics and trends and ability to identify gaps in care • Comprehensive knowledge of Microsoft Office Word, Excel, and PowerPoint • Ability to work 8:00 a.m.–5:00 p.m. Central Time • Willingness to travel at least 25% within the Texas, Arkansas, or Oklahoma region • Preferred: Master's Degree in Business, Finance, Health Care/Administration, RN, or a related field • Preferred: Experience with Medicare Risk Adjustment and/or medical coding • Preferred: Proven organizational and prioritization skills and ability to collaborate with multiple departments • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefícios

• Bonus incentive plan • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Telephone equipment provided for business requirements • Bi-weekly internet expense payment for employees who live and work from home in California, Illinois, Montana, or South Dakota • HireVue interview scheduling flexibility