[Hiring] Senior Network Performance Professional @Humana

Role Description

As a Senior Network Performance Professional at Humana, you will play a pivotal role in enhancing provider performance and advancing 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 strong relationship-building. This role offers a unique opportunity to leverage your expertise in healthcare provider relations to influence operational decisions and support the overall success of the organization.

• Operates with a high degree of independence, often determining methods/approach to work and establishing own work priorities and timelines.
• Work consists of tasks that are moderately complex, requiring minimal instructions to achieve solutions.
• May provide coaching and/or review the work of lower-level associates.
• Makes decisions on moderately complex issues; exercises discretion and judgment over policies and own approach/priorities.
• Work impacts the achievement of results for the department and begins to influence the department's strategy.

Qualifications

• Bachelor's Degree
• 2+ years of experience working with Medicare and/or managed care
• Working knowledge of NCQA and CMS Stars Rating System (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 focus on process and quality improvement
• Understanding of metrics, trends and the ability to identify gaps in care
• Must be able to work during 8-5pm (Central Time Zone)
• Must live within the region with a willingness to travel a minimum of 25% (Texas, Arkansas, or Oklahoma)

Requirements

• Master's Degree (Preferred)
• Experience with Medicare Risk Adjustment and/or medical coding (Preferred)
• Proven organizational and prioritization skills and ability to collaborate with multiple departments (Preferred)

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
• Many other opportunities

Company Description

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it.