Senior Network Performance Professional

CarePlus Health Plans Inc

Southeast Region, US
Base: $78,400 - $107,800 py; bonus: eligible for i...
Hybrid
4+ years medicare or managed care experience
Expertise in ncqa hedis and cms star ratings
Strong relationship building with physician groups
The Senior Network Performance Professional at CarePlus Health Plans Inc. is a pivotal role focused on enhancing provider performance and advancing quality healthcare in the Southeast Region. This hybrid position requires strong relationship-building skills and an understanding of Medicare systems to improve providers' STARs ratings through strategic initiatives

Job Summary

  • This role plays a pivotal part in enhancing provider performance within the Southeast Region to advance the mission of delivering high-quality healthcare.
  • The position involves actively monitoring provider data to identify improvement areas and educating physician groups on HEDIS, patient safety, and patient experience.
  • Humana offers competitive benefits including health coverage effective day one, a 401(k) match, tuition assistance, and paid time off.

Matching Summary

Match Score: 85

The Senior Network Performance Professional at CarePlus Health Plans Inc. is a pivotal role focused on enhancing provider performance and advancing quality healthcare in the Southeast Region. This hybrid position requires strong relationship-building skills and an understanding of Medicare systems to improve providers' STARs ratings through strategic initiatives.

Salary

Base: $78,400 - $107,800 per year; Bonus: Eligible for incentive plan based on performance; Benefits: Competitive medical, dental, vision, 401(k), and paid time off

Skills & Requirements

Must-have

  • 4+ years Medicare or managed care experience
  • Expertise in NCQA HEDIS and CMS Star Ratings
  • Strong relationship building with physician groups
  • Proficiency in Microsoft Office Word Excel PowerPoint
  • Ability to present to internal and external leadership

Nice-to-have

  • Bachelor's or Master's degree in related field
  • Experience with Medicare Risk Adjustment strategies
  • Knowledge of interoperability solutions in healthcare
  • Proven organizational and prioritization skills

Key Requirements

  • 4+ years experience with Medicare and/or managed care
  • Understanding of PQA Measures and CAHPS/HOS survey systems
  • Must be located within the Southeast region
  • Willingness to travel minimum of 10%

Work Rights

Not specified

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