Senior Network Performance Professional

Job Summary 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. 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 a focus on process and quality improvement. Comprehensive knowledge of all Microsoft Office Word, Excel and PowerPoint. Must be able to work during 8‑5 pm 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. 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. Travel Travel may be required up to 10% of the time, primarily for training or meetings. Schedule 40 hours per week (Monday‑Friday 8‑5 pm EST). Compensation The compensation range for this full‑time position is $78,400 - $107,800 per year, plus a bonus incentive plan based on company and/or individual performance. 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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our #J-18808-Ljbffr Humana Inc