Senior Healthcare Network Consultant

** Become a part of our caring community*
* Senior Network Performance Professional / Consultant at Humana, you will help enhance 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 relationship-building. You will report to the Manager, Network Performance.

As the Senior Network Performance Professional / Consultant you will

+ 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.

** Use your skills to make an impact*
* ** Required 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 Power Point

** Preferred Qualifications*
* + Bachelor's Degree

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

+ Experience presenting to internal and external customers, including high-level leadership

+ Progressive experience with interoperability solutions in Healthcare

+

Experience with Medicare Risk Adjustment and/or medical coding

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

+ 1 or more years' experience with tools such as Power BI, Tableau, Qlikview

** Additional Information*
* + You will work remote and this role have at least 10% of travel.

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 questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

** Work at Home Guidance*
* To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

+ Satellite, cellular and microwave connection can be used only if approved by leadership

+ Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

+ Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

+ Work from a dedicated space lacking ongoing interruptions…