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Become a part of our caring community and help us put health first

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.

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

In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:

+ Medical Benefits

+ Dental Benefits

+ Vision Benefits

+ Health Savings Accounts

+ Flex Spending Accounts

+ Life Insurance

+ 401(k)

+ PTO including 9 paid holidays, one personal holiday, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time

+ And more

Use your skills to make an impact

Required Qualifications

+ 3+ 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

+ Strong communication skills, both verbal and written

+ **Must be able to work during 8-5pm [Eastern]**

+ **Willingness to travel a minimum of 10%**

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

Work at Home/Remote Requirements

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 recommended to support Humana applications, per associate.

+ Wireless, Wired Cable or DSL connection is suggested.

+ Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership. (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.)

+ Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exception of associates who live or work from Home in the state of California, Illinois, Montana, or South Dakota. 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 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

Our Hiring Process

As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging, and/or Video Interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone or computer. You should anticipate this interview to take approximately 10-15 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

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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

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$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.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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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 https://www.humana.com/legal/accessibility-resources?source=Humana_Website.