Job Description

Become a part of our caring community

As a Senior Network Performance Professional 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 programs and relationship-building. You will have a unique opportunity to use your expertise in healthcare provider relations to influence operational decisions and support the success of the organization. Operate 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 review the work of lower-level associates. You will make decisions on moderately complex issues; 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.

Your responsibilities will not be limited to:

• Provider Collaboration: Work with providers to define and improve their goals related to interoperability, quality-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: monitor 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 internal 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 internal teams to report on market performance, ensuring alignment with organizational goals. Collaborate with cross-functional teams to lead programs that support provider performance improvement.

In addition to the requirements for this role, you will also have the following:

• Understanding of interoperability
• Understanding of Consumer/Patient Experience
• Strong communication and presentation skills, both verbal and written, and experience presenting to internal and external customers, including high-level leadership
• Understanding of metrics, trends, and the ability to identify gaps in care
• Organizational and prioritization skills and ability to collaborate with multiple departments

Use your skills to make an impact

Required Qualifications

• 5+ years of healthcare experience
• 3+ years of experience with Medicare and/or managed care
• Understanding of NCQA HEDIS measures, Patient Safety Measures, CMS Star Rating System and CAHPS/HOS survey system
• Experience building relationships with physician groups and influencing execution of recommended strategy
• Experience with focus on process and quality improvement
• Proven organizational and prioritization skills and ability to collaborate with multiple departments
• Must live in the state of Alabama
• Must be able to work 8am-5pm
• Willingness to travel a minimum of 10% within the region

Preferred Qualifications

• Bachelor’s Degree, RN or BSN (unrestricted compact license), or equivalent healthcare experience
• Experience with Medicare Risk Adjustment and/or medical coding
• Progressive experience with interoperability solutions in healthcare

Additional Information

This role is "remote/work at home", however, you must live/work within the state of Alabama to be considered for this opportunity.

Work at Home Information

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 upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees 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 employees 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.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

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

of Benefits

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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

About Humana: 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. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.