Manager, Provider Performance Management

HMSA; Honolulu (HI); On-site; USD 120,000 - 180,000; Full time

Job summary

HMSA in Hawaii seeks an experienced Provider Performance Manager to lead how we monitor and improve provider contract performance. You will oversee governance, analytics, and reporting, ensuring compliance with SLAs and regulatory requirements, while guiding negotiations and fee reviews.

This role collaborates across teams to optimize access and outcomes for members and drive continuous improvement. Jointly with cross-functional teams, you will implement data-driven strategies to improve

Responsibilities

• Lead provider performance management activities across contract requirements and SLAs.
• Oversee performance governance for provider services contracts, including reporting and penalties.
• Develop and measure provider network performance metrics (cost, quality, accessibility).
• Ensure regulatory network requirements are measured and reported (ACA, QUEST, Medicare, HMSA).
• Oversee data analysis for contract negotiations and fee reviews.
• Oversee out-of-network access strategies (single case agreements and network solutions).
• Perform all other duties as assigned.

Job description

Responsibilities

1. 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.
2. 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.
3. 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.
4. Ensure all regulatory network requirements are measured and reported according to listed requirements, such as:
   • ACA, QUEST, Medicare, HMSA
5. Oversee data analysis functions that support contract negotiations and fee reviews.
6. Oversee out of network provider access strategies including:
   • Single case agreements
   • Network access partner solutions
7. Perform all other miscellaneous responsibilities and duties as assigned or directed.