Manager, Provider Performance Management

HMSA • Honolulu, HI

78d

About The Position

The position involves leading provider performance management activities, monitoring technical, process, and business outcome metrics across all provider contract requirements and Service Level Agreements (SLAs). The role requires recommending actions for improvement and driving continuous improvement while overseeing and managing staff. Additionally, the position entails managing the performance governance aspects of provider services contracts, which includes enforcing compliance with contractual SLAs and deliverables, reviewing and validating performance reporting, capturing potential value leakage and/or service level penalties, coordinating the implementation of SLA reporting automation, and generating dashboards and reports for executive level briefing. The role also involves developing and measuring provider network performance metrics and objectives, ensuring all regulatory network requirements are measured and reported, overseeing data analysis functions that support contract negotiations and fee reviews, and managing out of network provider access strategies. Other miscellaneous responsibilities and duties may be assigned as directed.

Requirements

• 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 Word, Excel, Outlook, and PowerPoint.

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.
• 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.
• Ensure all regulatory network requirements are measured and reported according to listed requirements.
• Oversee data analysis functions that support contract negotiations and fee reviews.
• Oversee out of network provider access strategies.
• Perform all other miscellaneous responsibilities and duties as assigned or directed.

What This Job Offers

• Education Level: Bachelor's degree
• Number of Employees: 1,001-5,000 employees