Senior Network Performance Professional

This is a fully remote position, open to applicants in Oklahoma, +1 more state.

📋 Description

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

• Propose execution strategies and assess performance in relation to provider objectives.

• Act as a specialist on the Stars/Quality program, educating physician groups about HEDIS, patient safety, and the patient experience.

• Create customized action plans and convey actionable insights to enhance performance reward initiatives.

• Address provider abrasion concerns and implement strategies to boost provider satisfaction.

• Work alongside internal teams to monitor and report on market performance.

• Collaborate with cross-functional teams on initiatives aimed at improving provider performance.

• Oversee and evaluate provider performance data to pinpoint areas for improvement.

• Execute strategies for performance enhancement and provide continuous support and guidance to providers.

• Serve as a liaison with providers to facilitate access to Humana resources and self-service tools.

• Educate provider groups on reward programs and target metrics.

• Track and assess the effectiveness of reward programs and suggest improvements.

• Report directly to the Manager, Network Performance.

⛳️ Requirements

• Bachelor's Degree in Business, Finance, Health Care/Administration, RN, or a related field, or equivalent professional experience.

• Experience in Medicare and/or managed care environments.

• Familiarity with NCQA and CMS Stars Rating System, including HEDIS measures, PQA Measures, and the CAHPS/HOS survey system.

• Knowledge of clinical utilization and performance-improvement strategies.

• Ability to drive interoperability effectively.

• Understanding of consumer and patient experience dynamics.

• Proven experience in building relationships with physician groups and influencing the implementation of recommended strategies.

• Excellent verbal and written communication and presentation skills.

• Experience presenting to both internal and external stakeholders, including senior leadership.

• Background in process and quality improvement.

• Proficiency in metrics and trends, with the ability to identify care gaps.

• Extensive knowledge of Microsoft Office Suite, including Word, Excel, and PowerPoint.

• Availability to work from 8:00 a.m. to 5:00 p.m. Central Time.

• Willingness to travel at least 25% within the Texas, Arkansas, or Oklahoma regions.

• Preferred: Master's Degree in Business, Finance, Health Care/Administration, RN, or a related field.

• Preferred: Experience with Medicare Risk Adjustment and/or medical coding.

• Preferred: Strong organizational and prioritization skills with the ability to collaborate across multiple departments.

• Minimum home internet speed of 25 Mbps download and 10 Mbps upload.

• Capability to work from a dedicated space without interruptions to safeguard member PHI/HIPAA information.

🏝️ Benefits

• Bonus incentive plan.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Telephone equipment provided for business purposes.

• Bi-weekly internet expense reimbursement for employees residing and working from home in California, Illinois, Montana, or South Dakota.

• Flexibility in scheduling HireVue interviews.