Senior Network Performance Professional
Candidates must live in WA, OR, MT, or ID., 8:00 a.m. – 5:00 p.m. Pacific (PST) or Mountain (MST)Full-TimeSenior
Salary$78,400 - $107,800 per year
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Job Details
- Required Skills
- Microsoft Office
Requirements
- Bachelor's degree in business, finance, healthcare/administration, nursing (BSN), or equivalent work experience.
- Experience with Medicare and/or managed care.
- Understanding of NCQA HEDIS measures, PQA Measures, CMS Star Rating System, and CAHPS/HOS survey system.
- Understanding of Medicare Risk Adjustment and/or medical coding.
- Understanding of Consumer/Patient Experience.
- Ability to drive interoperability.
- Ability to identify gaps in care and drive process/quality improvement.
- Experience building relationships with physician groups and influencing execution.
- Strong communication and presentation skills.
- Comprehensive knowledge of Microsoft Office Word, Excel, and PowerPoint.
Responsibilities
- Work with providers to define and advance goals related to interoperability, quality, value-based arrangements, and risk adjustment.
- Serve as an expert on Stars/Quality programs and educate physician groups on HEDIS and patient experience.
- Analyze provider performance data to identify improvement opportunities.
- Act as a liaison for providers to access Humana resources and tools.
- Educate provider groups on reward programs and monitor effectiveness.
- Resolve provider abrasion issues to maintain collaborative relationships.
- Partner with internal teams to track and report on market performance.
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