Senior Healthcare Network Consultant

Become a part of our caring community and help us put health first

Senior Healthcare Network Consultant / 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.

• Provider Collaboration :
  Work with providers to define and advance 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 :
  Actively monitor and analyze provider performance data to identify areas for improvement. Implement strategies to enhance outcomes and provide ongoing support and guidance 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 internal teams to ensure seamless access to necessary resources and 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 as needed.

• Provider Abrasion Resolution: Resolve provider abrasion issues effectively, 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 internal teams to track and report on market performance, ensuring alignment with organizational goals.

Use your skills to make an impact

• 2 or more years of Experience with Medicare and/or managed care

• 3 or more years of NCQA HEDIS measures, PQA Measures, CMS Star Rating System and CAHPS/HOS survey system experience

• 1 or more years of experience 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 Microsoft Word, Excel and Power Point

• Work during 8am-5pm CST or EST

• Travel a minimum of 10%

• Live in EST or CST state

• Strong communication and presentation skills, both verbal and written, and experience presenting to internal and external customers, including high-level leadership

• Bachelor's Degree Understanding of and ability to drive interoperability

• Progressive experience with interoperability solutions in Healthcare

• Proven organizational and prioritization skills and ability to collaborate with multiple

• Experience with Medicare Risk Adjustment and/or medical coding

• Understanding of metrics, trends and the ability to identify gaps in care

• Lives in the region IN, KY, MI, OH, WV

• 1 or more years’ experience with tools such as Power BI, Tableau, Qlikview

As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the…