[Hiring] Senior Healthcare Network Consultant @Humana

Role Description

Become a part of our caring community as a Senior Network Performance Professional / Consultant at Humana, where you will help enhance provider performance and advance Humana's mission to deliver high-quality healthcare. You will work with providers to improve their STARs ratings and overall performance through strategic initiatives and relationship-building.

You will report to the Manager, Network Performance.

• Provider Collaboration: Work with providers to define and improve their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies.
• Stars/Quality Program Expertise: Serve as an expert on the Stars/Quality program, educating physician groups on HEDIS, patient safety, and patient experience. Collaborate to 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 providers on the use of self-serve tools. Facilitate communication between providers and our teams to ensure seamless access to necessary support.
• Reward Programs: Educate provider groups on reward programs and target metrics, collaborating to achieve established goals. Monitor and report on the effectiveness of reward programs, making recommendations for enhancements.
• Provider Abrasion Resolution: Resolve provider abrasion issues, ensuring a positive and collaborative relationship between Humana and its providers. Implement strategies to minimize provider abrasion and enhance overall satisfaction.
• Internal Collaboration: Partner with our teams to track and report market performance, ensuring alignment with organizational goals.

Qualifications

• 2 or more years of Experience with Medicare or managed care
• Live in CST or EST and work during 8am-5pm CST or EST
• 3 or more years of NCQA HEDIS measures, PQA Measures, CMS Star Rating System and CAHPS/HOS survey system
• 1 or more years of understanding of Consumer / Patient Experience
• 2 or more years of experience building relationships with physician groups and influencing execution of recommended strategy
• 1 or more years of experience with focus on process and quality improvement
• Comprehensive knowledge of all Microsoft Word, Excel and PowerPoint

Requirements

• Work remote with at least 10% travel.
• To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service must meet the following criteria:
• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Benefits

• Medical, dental and vision benefits
• 401(k) retirement savings plan
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• Short-term and long-term disability
• Life insurance and many other opportunities