[Remote] Sr. Network Performance Professional

Note: The job is a remote job and is open to candidates in USA. Humana Inc. is committed to putting health first and is seeking a Senior Network Performance Professional to enhance provider performance and support high-quality healthcare delivery. In this role, you will collaborate with providers to improve performance metrics and implement strategic initiatives that align with Humana's mission.


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

Skills

  • 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 MT
  • 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 Overview

  • Humana is a health insurance provider for individuals, families, and businesses. It was founded in 1964, and is headquartered in Louisville, Kentucky, USA, with a workforce of 10001+ employees. Its website is http://www.humana.com.

    • Company H1B Sponsorship

  • Humana has a track record of offering H1B sponsorships, with 282 in 2025, 246 in 2024, 284 in 2023, 274 in 2022, 212 in 2021, 84 in 2020. Please note that this does not guarantee sponsorship for this specific role.

    • Back to blog

    Common Interview Questions And Answers

    1. HOW DO YOU PLAN YOUR DAY?

    This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

    2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

    When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

    3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

    Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

    4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

    With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

    5. HOW DO YOU PROCESS INFORMATION?

    Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

    6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

    Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

    7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

    Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

    8. HOW TO PRIORITIZE WORK?

    The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

    9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

    Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

    10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

    This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...