What are the responsibilities and job description for the Manager, Provider Performance Management position at Hawaii Medical Service Association?
- 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.
#LI-Hybrid
Qualifications:
- Bachelor's degree and five years of related work experience or equivalent combination of education and related work experience.
- Three years of supervisory/management or leadership experience.
- Excellent oral and written communication skills.
- Excellent data analysis and reporting skills
- Strong understanding of legal and contractual terms used in provider contracts.
- Intermediate working knowledge of Microsoft Office applications. Including, but not limited to Word, Excel, Outlook, and PowerPoint.