At CenterWell Pharmacy, a Humana company, we are looking for a Senior Network Performance Professional to play a pivotal role in advancing our mission to deliver high-quality healthcare. You will enhance provider performance and STARs ratings through strategic initiatives and strong collaborative relationships.
What You'll Do
- 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.
- Resolve provider abrasion issues effectively, ensuring a positive and collaborative relationship.
- Partner with internal teams to track and report on market performance, ensuring alignment with organizational goals.
- Actively monitor and analyze provider performance data to identify areas for improvement and implement strategies to enhance outcomes.
- Act as a liaison for providers to access Humana resources, educating and encouraging providers on the use of self-serve tools.
- Educate provider groups on reward programs and target metrics, collaborating to achieve established goals.
What We're Looking For
- Bachelor's Degree in Business, Finance, Health Care/Administration, RN or a related field, or equivalent work experience.
- Experience with Medicare and/or managed care.
- Understanding of NCQA and CMS Stars Rating System (HEDIS measures, PQA Measures, and CAHPS/HOS survey system).
- Understanding of clinical utilization and levers to improve performance.
- Understanding of and ability to drive interoperability.
- Understanding of Consumer/Patient Experience.
- Experience building relationships with physician groups and influencing execution of recommended strategy.
- Strong communication and presentation skills, both verbal and written, and experience presenting to internal and external customers, including high-level leadership.
- Experience with focus on process and quality improvement.
- Understanding of metrics, trends and the ability to identify gaps in care.
- Comprehensive knowledge of all Microsoft Office Word, Excel and PowerPoint.
- Must be able to work during 8-5pm (Central Time Zone).
Nice to Have
- Master’s Degree in Business, Finance, Health Care/Administration, RN or a related field.
- Experience with Medicare Risk Adjustment and/or medical coding.
- Proven organizational and prioritization skills and ability to collaborate with multiple departments.
- Preference for candidates to live in Texas Panhandle area.
- Willingness to travel a minimum of 25% within region (Texas, Arkansas, or Oklahoma).
Technical Stack
- Microsoft Office Word
- Microsoft Office Excel
- Microsoft Office PowerPoint
Team & Environment
Operates with a high degree of independence, often determining methods/approach to work and establishing own work priorities and timelines. May provide coaching and/or review the work of lower-level associates.
Benefits & Compensation
- Compensation: $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.
Work Mode
This is a remote position with a preference for candidates in the Texas Panhandle area.
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.
