Senior Healthcare Network Consultant
Humana
full-time
Posted on:
Location Type: Remote
Location: Remote • Ohio, South Carolina, Tennessee, Texas, Virginia • 🇺🇸 United States
Visit company websiteSalary
💰 $78,400 - $107,800 per year
Job Level
Senior
About the role
- 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.
- Actively monitor and analyze provider performance data to identify areas for improvement.
- Implement strategies to enhance outcomes and provide ongoing support and guidance to providers.
- 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.
- Resolve provider abrasion issues effectively, ensuring a positive and collaborative relationship between Humana and its providers.
- Partner with internal teams to track and report on market performance, ensuring alignment with organizational goals.
Requirements
- 2 or more years of Experience with Medicare and/or managed care
- 3 or more years of NCQA HEDIS measures, PQA Measures, CMS Star Rating System and CAHPS/HOS survey system experience
- 1 or more years of experience 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 Microsoft Word, Excel and PowerPoint
- Work during 8am-5pm CST or EST
- Travel a minimum of 10%
- Live in EST or CST state
Benefits
- 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
- many other opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
Medicaremanaged careNCQA HEDIS measuresPQA MeasuresCMS Star Rating SystemCAHPS survey systemHOS survey systemprocess improvementquality improvementdata analysis
Soft skills
relationship buildinginfluencingcollaborationcommunicationproblem resolutioneducationsupportguidancemonitoringstrategic thinking