Humana
Overview
Senior Network Performance Professional at Humana. This role focuses on enhancing provider performance, improving STARs ratings, and supporting Humana's mission to deliver high-quality healthcare. The role offers independence in determining methods and work priorities and may involve coaching lower-level associates. Base pay range
$78,400.00/yr - $107,800.00/yr What you will do
Provider Collaboration: 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 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. Develop tailored action plans and communicate actionable insights to improve performance. Performance Improvement: Monitor and analyze provider performance data to identify areas for improvement. Implement strategies to enhance outcomes and provide ongoing support to providers. Resource Liaison: Act as a liaison for providers to access Humana resources, educating and encouraging use of self-serve tools. Facilitate communication between providers and internal teams to ensure access to resources and support. Reward Programs: Educate provider groups on reward programs and target metrics, monitoring effectiveness and recommending enhancements as needed. Provider Abrasion Resolution: Resolve provider abrasion issues, maintaining positive relationships and implementing strategies to minimize abrasion and enhance satisfaction. Internal Collaboration: Partner with internal teams to track and report market performance and drive cross-functional initiatives to support provider performance improvement. Required Qualifications
Bachelor’s degree in business, finance, health care/administration, nursing (BSN), or 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 understanding of metrics, trends, and gaps in care. Comprehensive knowledge of Microsoft Office Word, Excel, and PowerPoint. Candidates must live in WA, UT, ID, OR, or MT. Willingness to travel a minimum of 25% within region. Must be able to work during 8:00 a.m. – 5:00 p.m. Monday – Friday according to Pacific and/or Mountain time zones. Travel: Remote position with occasional travel to Humana offices for training or meetings may be required. Scheduled Weekly Hours
40 Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full-time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and demonstrated job-related skills, knowledge, experience, education, certifications, etc. $78,400 - $107,800 per year Benefits
Humana offers competitive benefits including medical, dental, and vision coverage, 401(k) with employer match, paid time off, holidays, disability and life insurance, and other opportunities. About Us
Humana Inc. (NYSE: HUM) is committed to putting health first for teammates, customers, and the company. Through Humana insurance and CenterWell healthcare services, we aim to help people achieve their best health and quality of life. Equal Opportunity Employer
Humana does not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. We comply with Section 503 of the Rehabilitation Act and VEVRAA and base employment decisions on valid job requirements.
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Senior Network Performance Professional at Humana. This role focuses on enhancing provider performance, improving STARs ratings, and supporting Humana's mission to deliver high-quality healthcare. The role offers independence in determining methods and work priorities and may involve coaching lower-level associates. Base pay range
$78,400.00/yr - $107,800.00/yr What you will do
Provider Collaboration: 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 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. Develop tailored action plans and communicate actionable insights to improve performance. Performance Improvement: Monitor and analyze provider performance data to identify areas for improvement. Implement strategies to enhance outcomes and provide ongoing support to providers. Resource Liaison: Act as a liaison for providers to access Humana resources, educating and encouraging use of self-serve tools. Facilitate communication between providers and internal teams to ensure access to resources and support. Reward Programs: Educate provider groups on reward programs and target metrics, monitoring effectiveness and recommending enhancements as needed. Provider Abrasion Resolution: Resolve provider abrasion issues, maintaining positive relationships and implementing strategies to minimize abrasion and enhance satisfaction. Internal Collaboration: Partner with internal teams to track and report market performance and drive cross-functional initiatives to support provider performance improvement. Required Qualifications
Bachelor’s degree in business, finance, health care/administration, nursing (BSN), or 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 understanding of metrics, trends, and gaps in care. Comprehensive knowledge of Microsoft Office Word, Excel, and PowerPoint. Candidates must live in WA, UT, ID, OR, or MT. Willingness to travel a minimum of 25% within region. Must be able to work during 8:00 a.m. – 5:00 p.m. Monday – Friday according to Pacific and/or Mountain time zones. Travel: Remote position with occasional travel to Humana offices for training or meetings may be required. Scheduled Weekly Hours
40 Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full-time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and demonstrated job-related skills, knowledge, experience, education, certifications, etc. $78,400 - $107,800 per year Benefits
Humana offers competitive benefits including medical, dental, and vision coverage, 401(k) with employer match, paid time off, holidays, disability and life insurance, and other opportunities. About Us
Humana Inc. (NYSE: HUM) is committed to putting health first for teammates, customers, and the company. Through Humana insurance and CenterWell healthcare services, we aim to help people achieve their best health and quality of life. Equal Opportunity Employer
Humana does not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. We comply with Section 503 of the Rehabilitation Act and VEVRAA and base employment decisions on valid job requirements.
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