Senior Network Professional

Position: Senior Network Performance Professional
** Become a part of our caring community*
* 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.

The Senior Network Performance Professional operates with a high degree of independence, often determining methods/approach to work and establishing own work priorities and timelines. The work generally consists of tasks that are moderately complex, requiring minimal instructions to achieve solutions. Also, you will make decisions on moderately complex issues; exercises discretion and judgment over policies and own approach/priorities. Additionally, the work you do will impact the achievement of results for the department and begin to influence the department's strategy.

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* Key responsibilities include:

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* ** Provider Collaboration** :
Work with providers to define and advance their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies. Recommend execution strategies and monitor performance toward these goals.

** 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. Collaborate with cross-functional teams to drive initiatives that support provider performance improvement.

** Use your skills to make an impact*
* ** Required Qualifications*
* + Bachelor's degree

+ 3+ years of experience in healthcare, Medicare and/or managed care

+ Understanding of NCQA HEDIS measures, PQA Measures, CMS Star Rating System and CAHPS/HOS survey system

+ Ability to drive interoperability and understanding of Consumer/Patient Experience.

+ Experience building relationships with physician groups and influencing execution of recommended strategy

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

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Experience with process and quality improvement, with an understanding of metrics, trends, and the ability to identify gaps in care.

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

+ Comprehensive knowledge of all Microsoft Office Word, Excel and Power Point

+ Must be able to work during 8-5pm Mountain or Pacific

+ Must reside within one of the following regions:
Colorado, Nevada, Arizona, New Mexico, Hawaii or California.

+ Willingness to travel a minimum of 10%

** Preferred Qualifications*
* + Master's Degree in Business, Finance, Health Care/Administration, RN or a related field

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Experience with Medicare Risk Adjustment and/or medical coding

** Additional Information:*
* This role is "remote/work at home", however, you must live within the region to be considered for this opportunity (Colorado, Nevada, Arizona, New Mexico, Hawaii or California)

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from  with instructions on how to add the information into your official application on Humana's secure website.

Work at Home Requirements To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an…