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HMSA · 3 hours ago

Manager, Provider Performance Management

Honolulu, HI

Full-time

Hybrid

Mid, Senior Level

$68K/yr - $133K/yr

5+ years exp

HMSA is seeking a Manager for Provider Performance Management who will be responsible for performance governance across multiple provider contracts and ensuring regulatory network requirements are measured and reported. The role involves leading performance management activities, managing compliance with contractual SLAs, and developing network performance metrics.

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