Senior Network Performance Professional

Become a part of our caring community

As a Senior Network Performance Professional at Humana, you will play a pivotal role in enhancing 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 strong relationship-building. This role offers a unique opportunity to leverage your expertise in healthcare provider relations to influence operational decisions and support the overall success of the organization. May provide coaching and/or review the work of lower-level associates. You will report to the Associate Director, Network Performance.

Key Responsibilities

• Provider Collaboration: Work with providers to define and advance their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies. Recommend execution strategies and monitor performance toward these goals.
• 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: 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.
• 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 internal teams to ensure seamless access to necessary resources and 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 as needed.
• Provider Abrasion Resolution: Resolve provider abrasion issues effectively, 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 internal teams to track and report on market performance, ensuring alignment with organizational goals. Collaborate with cross-functional teams to drive initiatives that support provider performance improvement.

Use your skills to make an impact

Required Qualifications

• 3+ years' experience with Medicare and/or managed care
• Experience building relationships with physician groups and influencing execution of recommended strategy
• Experience with focus on process and quality improvement
• Proven organizational and prioritization skills and ability to collaborate with multiple departments
• In-depth experience in Microsoft Excel including formulas, pivots, charts, and graphs.
• Comprehensive knowledge of Microsoft Office Applications including Word and PowerPoint
• Must be able to work during 8am-5pm
• Ability and willingness to travel up to 10% of the time

Preferred Qualifications

• Bachelor's degree
• RN or BSN (unrestricted compact license)
• 5+ years' experience with Medicare and/or managed care
• Experience with Medicare Risk Adjustment and/or medical coding
• Progressive experience with interoperability solutions in healthcare
• 2+ years of experience working with NCQA HEDIS measures, PQA Measures, CMS Star Rating System and CAHPS/HOS survey system
• Experience with SQL including the ability to create reports from scratch and run existing reports
• Experience with tools such as Power BI, Power Apps, and/or Microsoft Access for running analysis, automating processes, or creating dashboards, self-service tools, and data visualizations
• Data analysis, experience with relational databases
• Live within region: Louisiana, Mississippi, Alabama, or Tennessee

Additional Information

Work-At-Home Requirements

• To 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 required; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees 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 information

Our Hiring Process

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected, you will receive correspondence inviting you to participate in a HireVue assessment. You will have a set of questions and you will provide responses to each question. You should anticipate this to take about 10-15 minutes. Your answers will be reviewed, and you will subsequently be informed if you will be moving forward to next round.

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Travel: While this is a remote position, occasional travel to Humana''s offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$78,400 - $107,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.

Application Deadline: 05-01-2026

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

Equal Opportunity Employer

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. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.