Senior Network Performance Professional

Senior Network Performance Professional 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. You will report to the Manager, Network Performance. Key Responsibilities Recommend execution strategies to providers to advance their goals related to interoperability, quality, value‑based arrangements, and risk adjustment strategies Serve as an expert on the Stars/Quality program, educating physician groups on HEDIS, patient safety, and patient experience Actively monitor and analyze provider performance data to identify areas for improvement 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 Educate provider groups on reward programs and target metrics and monitor effectiveness of reward programs, collaborating to achieve established goals Resolve provider abrasion issues effectively, ensuring a positive and collaborative relationship between Humana and its providers Partner with internal and cross‑functional teams to track and report on market performance, ensuring alignment with organizational goals Benefits Health benefits effective day 1 Paid time off, holidays, volunteer time and jury duty pay Recognition pay 401(k) retirement savings plan with employer match Tuition assistance Scholarships for eligible dependents Parental and caregiver leave Employee charity matching program Network Resource Groups (NRGs) Career development opportunities Required Qualifications 4+ years' experience with Medicare Advantage Understanding of NCQA HEDIS measures, PQA Measures, CMS Star Rating System and CAHPS/HOS survey system Experience building relationships with physician groups and influencing execution of recommended strategy Understanding of Consumer/Patient Experience Understanding of metrics, trends and the ability to identify gaps in care Understanding of and ability to drive interoperability Experience presenting to internal and external customers, including high-level leadership Experience with focus on process and quality improvement Comprehensive knowledge of all Microsoft Office Word, Excel and PowerPoint Must be able to work during 8-5pm EST Travel up to 10% Preferred Qualifications Experience with Medicare Risk Adjustment and/or medical coding Progressive experience with interoperability solutions in Healthcare Bachelor's Degree in Business, Finance, Health Care/Administration, RN or a related field Work‑At‑Home Requirements To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self‑provided internet service of Home or Hybrid Home/Office associates 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 associates 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 Scheduled Weekly Hours 40 Pay Range $78,400 – $107,800 per year Description Of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offer 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 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. 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. #J-18808-Ljbffr Humana