Senior Healthcare Network Consultant

Become a part of our caring community

As a 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.

Use your skills to make an impact

Required Qualifications

• 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 PowerPoint

Preferred Qualifications

• 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

Additional Information

• You will work remote and this role has at least 10% of travel.
• As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue.

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service 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.
• 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 telephone equipment appropriate to meet the business requirements.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Scheduled Weekly Hours

40

Pay Range

$78,400 - $107,800 per year. This job is eligible for a bonus incentive plan based upon company and/or individual performance.

Description of Benefits

Humana offers competitive benefits that support whole-person well-being, including medical, dental and vision benefits, 401(k) retirement savings plan, time off, disability, life insurance and more.

About us

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.

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. #LI-BB1