Senior Healthcare Network Consultant

Become a part of our caring community Senior Network Performance Professional / Consultant at Humana, you will help enhance 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 relationship-building. You will report to the Manager, Network Performance.As the Senior Network Performance Professional / Consultant you willProvider 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. Use your skills to make an impact Required Qualifications2 or more years of Experience with Medicare or managed careLive in CST or EST and work during 8am-5pm CST or EST3 or more years of NCQA HEDIS measures, PQA Measures, CMS Star Rating System and CAHPS/HOS survey system1 or more years of understanding of Consumer / Patient Experience2 or more years of experience building relationships with physician groups and influencing execution of recommended strategy1 or more years of experience with focus on process and quality improvementComprehensive knowledge of all Microsoft Word, Excel and PowerPointPreferred QualificationsBachelor's DegreeLives in the region IN, KY, MI, OH, WVExperience presenting to internal and external customers, including high-level leadershipProgressive experience with interoperability solutions in HealthcareExperience with Medicare Risk Adjustment and/or medical codingUnderstanding of metrics, trends and the ability to identify gaps in care1 or more years' experience with tools such as Power BI, Tableau, QlikviewAdditional InformationYou will work remote and this role have at least 10% of travel.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 Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 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.Work at Home GuidanceTo 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; wireless, wired cable or DSL connection is suggestedSatellite, cellular and microwave connection can be used only if approved by leadershipAssociates 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 informationWork at Home RequirementsTo ensure Home or Hy