Humana
10,000+ employees
Founded 1961
🏥 Healthcare
🛡️ Insurance
⚕️ Healthcare Insurance
Healthcare • Insurance • Healthcare Insurance
Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.
Senior Network Performance Professional
🕒 August 7
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Humana
10,000+ employees
Founded 1961
🏥 Healthcare
🛡️ Insurance
⚕️ Healthcare Insurance
Healthcare • Insurance • Healthcare Insurance
Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.
📋 Description
• 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
🎯 Requirements
• 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
🏖️ Benefits
• 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
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