Note: The job is a remote job and is open to candidates in USA. Humana is a leading U.S. healthcare company that aims to improve the quality of life for people with Medicare and Medicaid. The Senior Healthcare Network Consultant will drive provider performance through strategic initiatives and collaboration, focusing on enhancing outcomes and supporting high-quality healthcare delivery.
Responsibilities
- 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
Skills
- 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
- Bachelor's Degree
- Lives in the region IN, KY, MI, OH, WV
- Experience presenting to internal and external customers, including high-level leadership
- Progressive experience with interoperability solutions in Healthcare
- Experience with Medicare Risk Adjustment and/or medical coding
- Understanding of metrics, trends and the ability to identify gaps in care
- 1 or more years' experience with tools such as Power BI, Tableau, Qlikview
Benefits
- Bonus incentive plan
- 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
- Bi-weekly payment for internet expense for associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota
- Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job
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