Senior Network Performance Professional

🔥 0 minutes ago

🌪️ Oklahoma, Texas – Remote

🌪️ Oklahoma – Remote 🤠 Texas – Remote

💵 $78.4k - $107.8k / year

⏰ Full Time

🟠 Senior

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Humana

WebsiteLinkedInAll Job Openings

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 Stars/Quality programs, educating 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 minimize provider abrasion • 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 opportunities • Implement strategies to enhance outcomes and support providers • Liaise between providers and Humana resources, promoting self-service tools • Educate provider groups on reward programs and target metrics • Monitor and report reward program effectiveness and recommend enhancements • Operate independently, establish work priorities and timelines, and make moderately complex decisions • Provide coaching and/or review lower-level associates' work • Report to the Manager, Network Performance

🎯 Requirements

• Bachelor's Degree • 2+ years of experience working with Medicare and/or managed care • Working knowledge of NCQA and CMS Stars Rating System, including HEDIS measures, PQA Measures, and CAHPS/HOS survey system • Understanding of clinical utilization and levers to improve performance • Understanding of and ability to drive interoperability • Understanding of Consumer/Patient Experience • Experience building relationships with physician groups and influencing execution of recommended strategy • Experience with process and quality improvement • Understanding of metrics, trends, and ability to identify gaps in care • Must be able to work during 8–5pm Central Time • Must live within Texas, Arkansas, or Oklahoma, with willingness to travel a minimum of 25% • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • Dedicated workspace without ongoing interruptions to protect PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • 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 • Dedicated home workspace arrangement • Remote/work-at-home arrangement • Occasional travel to Humana offices for training or meetings