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Humana

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.

Senior Healthcare Network Consultant

Network EngineerNetwork EngineerFull TimeRemoteSeniorTeam 10,001+Since 1961H1B SponsorCompany SiteLinkedIn

Location

United States

Posted

3 days ago

Salary

$78.4K - $107.8K / year

Seniority

Senior

Job Description

Senior Healthcare Network Consultant

Humana

Role Description Become a part of our caring community as a Senior Network Performance Professional / Consultant at Humana, where you will help enhance provider performance and advance 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 relationship-building. You will report to the Manager, Network Performance. - Provider Collaboration: Work with providers to define and improve 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: Monitor and analyze provider performance data to identify areas for improvement. Implement strategies to enhance outcomes and provide ongoing support 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 our teams to ensure seamless access to necessary 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. - Provider Abrasion Resolution: Resolve provider abrasion issues, 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 our teams to track and report market performance, ensuring alignment with organizational goals. Qualifications - 2 or more years of Experience with Medicare or managed care - Live in CST or EST and work during 8am-5pm CST or EST - 3 or more years of NCQA HEDIS measures, PQA Measures, CMS Star Rating System and CAHPS/HOS survey system - 1 or more years of 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 all Microsoft Word, Excel and PowerPoint Requirements - Work remote with at least 10% travel. - To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service 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. - Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. - While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Benefits - Medical, dental and vision benefits - 401(k) retirement savings plan - Time off (including paid time off, company and personal holidays, paid parental and caregiver leave) - Short-term and long-term disability - Life insurance and many other opportunities

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