Key skills
Leadership
About this role
Role Overview
- Work with SouthEast Region 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
- Actively monitor and analyze provider performance data to identify areas for improvement
- Be 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 applicable insights to improve performance
- Implement strategies to enhance outcomes and provide ongoing support and guidance to providers
- Be 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
- Monitor and reports on the effectiveness of reward programs, making recommendations for enhancements
- Resolve provider abrasion issues, ensuring a positive and collaborative relationship between Humana and its providers
- Collaborate with teams to drive initiatives that support provider performance improvement
Requirements
- 5 or more years' experience with Medicare and/or managed care
- Understanding of NCQA HEDIS measures, PQA Measures, CMS Star Rating System and CAHPS/HOS survey system
- Experience building relationships with physician groups and influencing execution of recommended strategy
- Comprehensive knowledge of all Microsoft Office Word, Excel and PowerPoint
- Experience presenting to internal and external customers, including high-level leadership
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