Humana · 14 hours ago
Senior Network Performance Professional
Idaho, United States
Full-time
Hybrid
Mid, Senior Level
$78K/yr - $108K/yrHumana Inc. is committed to putting health first, and they are seeking a Senior Network Performance Professional to enhance provider performance. The role involves collaborating with providers to improve their STARs ratings and overall performance through strategic initiatives and relationship-building.
Health CareHealth InsuranceInsuranceVenture Capital
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
Qualification
Required
Bachelor's degree in business, finance, health care/administration, nursing (BSN), or a related field, or equivalent work experience
Experience with Medicare Risk Adjustment and/or medical coding
Experience with Medicare and/or managed care
Understanding of NCQA HEDIS measures, PQA Measures, CMS Star Rating System, and CAHPS/HOS survey system
Ability to drive interoperability and understanding of Consumer/Patient Experience
Proven experience building relationships with physician groups and influencing execution of recommended strategies
Strong communication and presentation skills, both verbal and written, with experience presenting to internal and external customers, including high-level leadership
Focus on process and quality improvement, with an understanding of metrics, trends, and the ability to identify gaps in care
Comprehensive knowledge of Microsoft Office Word, Excel, and PowerPoint
Candidates must live in WA, OR, ID, MT, or UT
Willingness to travel a minimum of 25% within region
Must be able to work during 8:00 a.m. – 5:00 p.m. Monday – Friday according to Pacific (PST) or Mountain (MST) time zones
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
Company
Humana
Humana is a health insurance provider for individuals, families, and businesses.
Founded in 1964
10001+ employees
H1B Sponsorship
Humana has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (282)
2024 (246)
2023 (284)
2022 (274)
2021 (212)
2020 (84)
Funding
Current Stage
Public CompanyTotal Funding
$13.07B2025-05-30Post Ipo Debt· $5B
2025-03-03Post Ipo Debt· $1.25B
2024-03-11Post Ipo Debt· $2.25B
Leadership Team
Jim Rechtin
CEO and President
Colin Drylie
Senior Vice President, Experience Transformation
Recent News
2026-01-07
2026-01-06
2026-01-04
Company data provided by crunchbase