Apply on Employer Site

HMSA · 3 months ago

Manager, Provider Performance Management

Honolulu, HI, 96814, United States

Full-time

Hybrid

Mid, Senior Level

HMSA is a healthcare organization, and they are seeking a Manager for Provider Performance Management. The role involves leading performance management activities, ensuring compliance with service level agreements, and overseeing data analysis functions to support contract negotiations.

AssociationHealth CareInsuranceMedical

Responsibilities

Lead provider performance management activities. Monitor technical, process, and business outcome metrics across all provider contract requirements and Service Level Agreements (SLAs). Recommend actions for improvement and drive continuous improvement. Oversee and manage staff

Manage the performance governance aspects of provider services contracts. These activities include: * Enforce compliance with the contractual SLAs and deliverables. * Review and validate performance reporting. * Capture potential value leakage and/or service level penalties. * Coordinate implementation of SLA reporting automation. * Generate dashboards and reports for executive level briefing

Develop and measure provider network performance metrics and objectives, such as: * Cost, quality, and accessibility reporting. * Network reporting supportive of open enrollment and RFP's

Ensure all regulatory network requirements are measured and reported according to listed requirements, such as: * ACA, QUEST, Medicare, HMSA

Oversee data analysis functions that support contract negotiations and fee reviews

Oversee out of network provider access strategies including: * Single case agreements * Network access partner solutions

Perform all other miscellaneous responsibilities and duties as assigned or directed

Qualification

Provider performance managementPerformance governanceData analysisSLA complianceRegulatory requirementsContinuous improvementStaff managementDashboard generation