Senior Healthcare Network Consultant
About the position Become a part of our caring community and help us put health first Senior Healthcare Network Consultant / 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. Senior Healthcare Network Consultant /Senior Network Performance Professional Provider Collaboration: Work with providers to define and advance 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: Actively monitor and analyze provider performance data to identify areas for improvement. Implement strategies to enhance outcomes and provide ongoing support and guidance 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 internal teams to ensure seamless access to necessary resources and 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 as needed. Provider Abrasion Resolution: Resolve provider abrasion issues effectively, 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 internal teams to track and report on market performance, ensuring alignment with organizational goals. Use your skills to make an impact
Responsibilities
- Work with providers to define and 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.
- Collaborate to develop tailored action plans and communicate actionable insights to improve performance.
- Actively monitor and analyze provider performance data to identify areas for improvement.
- Implement strategies to enhance outcomes and provide ongoing support and guidance to providers.
- 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, collaborating to achieve established goals.
- Monitor and report on the effectiveness of reward programs, making recommendations for enhancements as needed.
- Resolve provider abrasion issues effectively, ensuring a positive and collaborative relationship between Humana and its providers.
- Implement strategies to minimize provider abrasion and enhance overall satisfaction.
- Partner with internal teams to track and report on market performance, ensuring alignment with organizational goals.
Requirements
- 2 or more years of Experience with Medicare and/or managed care
- 3 or more years of NCQA HEDIS measures, PQA Measures, CMS Star Rating System and CAHPS/HOS survey system experience
- 1 or more years of experience 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 Microsoft Word, Excel and PowerPoint
- Work during 8am-5pm CST or EST
- Travel a minimum of 10%
- Live in EST or CST state
Nice-to-haves
- Strong communication and presentation skills, both verbal and written, and experience presenting to internal and external customers, including high-level leadership
- Bachelor's Degree
- Understanding of and ability to drive interoperability
- Progressive experience with interoperability solutions in Healthcare
- Proven organizational and prioritization skills and ability to collaborate with multiple
- Experience with Medicare Risk Adjustment and/or medical coding
- Understanding of metrics, trends and the ability to identify gaps in care
- Lives in the region IN, KY, MI, OH, WV
- 1 or more years’ experience with tools such as Power BI, Tableau, Qlikview
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.
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