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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Medicare and managed care, focusing on provider performance improvement through data analysis, quality programs, and effective communication. Capable of developing actionable insights and strategies to enhance provider outcomes and patient experience.
Highest-signal resume keywords
Medicare ExperienceNCQA KnowledgeCMS Stars Rating SystemHEDIS MeasuresProcess Improvement
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Interoperability StrategiesQuality ImprovementData AnalysisPerformance MonitoringPatient Experience Metrics
Soft Skills
Relationship BuildingInfluencing StrategyCoachingCommunication
Tools & Technologies
Self-Service ToolsPerformance Reporting Systems
Certifications & Qualifications
Bachelor's Degree
Industry Keywords
Value-Based ArrangementsRisk Adjustment StrategiesProvider PerformancePHI/HIPAA ComplianceConsumer Experience
About the role
Key responsibilities & impact- Work with providers to define and advance goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies
- Recommend execution strategies and monitor performance toward provider goals
- Serve as an expert on Stars/Quality programs, educating physician groups on HEDIS, patient safety, and patient experience
- Develop tailored action plans and communicate actionable insights to improve performance reward programs
- Resolve provider abrasion issues and minimize provider abrasion
- Partner with internal teams to track and report market performance
- Collaborate with cross-functional teams on provider performance improvement initiatives
- Monitor and analyze provider performance data to identify improvement opportunities
- Implement strategies to enhance outcomes and support providers
- Liaise between providers and Humana resources, promoting self-service tools
- Educate provider groups on reward programs and target metrics
- Monitor and report reward program effectiveness and recommend enhancements
- Operate independently, establish work priorities and timelines, and make moderately complex decisions
- Provide coaching and/or review lower-level associates' work
- Report to the Manager, Network Performance
Requirements
What you’ll need- Bachelor's Degree
- 2+ years of experience working with Medicare and/or managed care
- Working knowledge of NCQA and CMS Stars Rating System, including HEDIS measures, PQA Measures, and CAHPS/HOS survey system
- Understanding of clinical utilization and levers to improve performance
- Understanding of and ability to drive interoperability
- Understanding of Consumer/Patient Experience
- Experience building relationships with physician groups and influencing execution of recommended strategy
- Experience with process and quality improvement
- Understanding of metrics, trends, and ability to identify gaps in care
- Must be able to work during 8–5pm Central Time
- Must live within Texas, Arkansas, or Oklahoma, with willingness to travel a minimum of 25%
- Minimum home internet speed of 25 Mbps download and 10 Mbps upload
- Dedicated workspace without ongoing interruptions to protect PHI/HIPAA information
Benefits
Comp & perks- Bonus incentive plan based on company and/or individual performance
- Medical benefits
- Dental benefits
- Vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company holidays
- Personal holidays
- Paid parental leave
- Paid caregiver leave
- Short-term disability
- Long-term disability
- Life insurance
- Dedicated home workspace arrangement
- Remote/work-at-home arrangement
- Occasional travel to Humana offices for training or meetings