Senior Healthcare Network Consultant

This is a fully remote position, open to applicants in Ohio, +4 more states.

📋 Description

• Collaborate with providers to establish and enhance their objectives concerning interoperability, quality, value-based arrangements, and risk adjustment strategies.

• Function as a subject matter expert on the Stars/Quality program, providing education to physician groups on HEDIS, patient safety, and patient experience.

• Work together to create customized action plans and convey actionable insights to boost performance.

• Monitor and assess provider performance data to pinpoint areas needing improvement.

• Execute strategies to improve outcomes and offer continuous support to providers.

• Serve as a liaison for providers to access Humana resources, educating and motivating them to utilize self-service tools.

• Facilitate communication between providers and our teams to ensure uninterrupted access to essential support.

• Inform provider groups about reward programs and target metrics, collaborating to meet defined goals.

• Address provider abrasion issues, fostering a positive and cooperative relationship between Humana and its providers.

• Collaborate with our teams to monitor and report market performance, ensuring alignment with organizational objectives.

⛳️ Requirements

• At least 2 years of experience in Medicare or managed care.

• Reside in CST or EST and work during the hours of 8am-5pm CST or EST.

• A minimum of 3 years of experience with NCQA HEDIS measures, PQA Measures, CMS Star Rating System, and CAHPS/HOS survey system.

• At least 1 year of understanding of Consumer/Patient Experience.

• A minimum of 2 years of experience in building relationships with physician groups and influencing the execution of recommended strategies.

• At least 1 year of experience focusing on process and quality improvement.

• Extensive knowledge of Microsoft Word, Excel, and PowerPoint.

🏝️ Benefits

• 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.