CenterWell Pharmacy, part of Humana, is looking for a Senior Network Performance Professional to enhance provider performance and advance our mission to deliver high-quality healthcare. You will work independently with physician groups, focusing on strategic initiatives to improve their STARs ratings and overall performance. This role involves building strong relationships and driving measurable improvements in care quality and patient experience.
What You'll Do
- Work with providers to define and advance goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies.
- Serve as an expert on the Stars/Quality program, educating groups on HEDIS, patient safety, and patient experience to develop tailored action plans.
- Actively monitor and analyze provider performance data, implementing strategies to enhance outcomes and providing ongoing support.
- Act as a liaison, educating providers on self-serve tools and facilitating communication between providers and internal Humana teams.
- Educate provider groups on reward programs and target metrics, collaborating to achieve goals and monitoring program effectiveness.
- Resolve provider abrasion issues effectively to maintain positive, collaborative relationships.
- Partner with internal teams to track and report on market performance, ensuring alignment with organizational goals.
What We're Looking For
- Bachelor’s degree in business, finance, health care/administration, nursing (BSN), or a related field, or equivalent work experience.
- Experience with Medicare Risk Adjustment and/or medical coding.
- Experience with Medicare and/or managed care.
- Understanding of NCQA HEDIS measures, PQA Measures, CMS Star Rating System, and CAHPS/HOS survey system.
- Ability to drive interoperability and understanding of Consumer/Patient Experience.
- Proven experience building relationships with physician groups and influencing execution of recommended strategies.
- Strong communication and presentation skills, with experience presenting to internal/external customers, including high-level leadership.
- Focus on process and quality improvement, with an understanding of metrics, trends, and the ability to identify gaps in care.
- Comprehensive knowledge of Microsoft Office Word, Excel, and PowerPoint.
- Candidates must live in WA, OR, ID, MT, or UT.
- Willingness to travel a minimum of 25% within region.
- Ability to work 8:00 a.m. – 5:00 p.m. Monday – Friday according to Pacific (PST) or Mountain (MST) time zones.
- Ability to work from a dedicated, interruption-free space to protect member PHI / HIPAA information.
Technical Stack
- Microsoft Office Word
- Microsoft Office Excel
- Microsoft Office PowerPoint
Team & Environment
You will operate with a high degree of independence, determining your methods and establishing your own priorities. The role may involve providing coaching and/or reviewing the work of lower-level associates.
Benefits & Compensation
- Compensation range: $78,400 - $107,800 per year
- 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
- Bonus incentive plan based upon company and/or individual performance
- Bi-weekly payment for internet expense for employees in California, Illinois, Montana, or South Dakota
- Telephone equipment provided
Work Mode
This is a hybrid position open to candidates located in Washington, Oregon, Idaho, Montana, or Utah.
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.
