Senior Healthcare Network Consultant

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Senior Network Performance Professional / Consultant at Humana, 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.

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.

• 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

• 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

• You will work remote and this role have at least 10% of travel.

• 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 to protect member PHI / HIPAA information

40

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 individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$78,400 - $107,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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.

About Humana:
Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance…