Senior Network Performance Professional

Become a part of our caring community As a Senior Network Performance Professional at Humana, you will play a pivotal role in enhancing provider performance within the Southeast Region 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. You will report to the Manager, Network Performance. Key Responsibilities Works with Southeast Region providers to define and advance their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies Recommends execution strategies and monitor performance toward these goals Actively monitors and analyzes provider performance data to identify areas for improvement Serves as an expert on the Stars/Quality program, educating physician groups on HEDIS, patient safety, and patient experience Collaborates to develop tailored action plans and communicate actionable insights to improve performance Implements strategies to enhance outcomes and provide ongoing support and guidance to providers Acts as a liaison for providers to access Humana resources, educating and encouraging providers on the use of self‑serve tools Facilitates communication between providers and internal teams to ensure seamless access to necessary resources and support Educates provider groups on reward programs and target metrics, collaborating to achieve established goals Monitors and reports on the effectiveness of reward programs, making recommendations for enhancements as needed Resolves provider abrasion issues effectively, ensuring a positive and collaborative relationship between Humana and its providers Implements strategies to minimize provider abrasion and enhance overall satisfaction Partners with internal teams to track and report on market performance, ensuring alignment with organizational goals Collaborates with cross-functional teams to drive initiatives that support provider performance improvement Humana offers a variety of benefits to promote the best health and well‑being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including: 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 Use your skills to make an impact Required Qualifications 4+ years' experience with Medicare and/or managed care 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 Comprehensive knowledge of all Microsoft Office Word, Excel and PowerPoint Experience presenting to internal and external customers, including high‑level leadership Must be able to work during 8-5pm [Eastern] Willingness to travel a minimum of 10% Must be located within the Southeast region Preferred Qualifications Bachelor's Degree or Master's degree in business, Finance, Health Care/Administration, RN or a related field Experience with Medicare Risk Adjustment Progressive experience with interoperability solutions in Healthcare Proven organizational and prioritization skills and ability to collaborate with multiple departments Additional Information This role is "remote/work at home", however, you must live within the Southeast region 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 Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range $78,400 - $107,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers 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. 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