Provider Engagement Manager

HMSA; Honolulu (HI); Hybrid; USD 120,000 - 170,000; Full time

Job summary

HMSA in Hawaii seeks a Provider Pod Leader to drive collaboration across provider organizations, lead recurring Pod meetings, develop agendas, and coordinate with internal experts to advance performance. The role emphasizes data-driven discussion and accountability to improve outcomes across the network.

The position focuses on value-based performance management, including revenue cycle optimization, RAF/HCC coding opportunities, and cross-functional partnership with Revenue Cycle, Clinical

Qualifications

• Lead recurring Provider Pod meetings for assigned provider organizations.
• Develop meeting agendas and facilitate productive discussions.
• Coordinate participation from internal subject matter experts.
• Track action items and ensure accountability for completion.
• Aggregate data with the Senior Financial Analyst and the Senior Data Analyst.
• Present findings in the POD meetings to rank-and-file providers.

Responsibilities

• Lead performance reviews and action planning related to: Revenue cycle optimization and issue resolution
• Medicare STAR quality gap closure opportunities
• Risk Adjustment Factor (RAF) optimization
• Suspect condition validation and documentation improvement
• HCC coding opportunities
• Cost of care reduction initiatives
• Emergency Department utilization
• Hospital admissions
• Readmission reduction
• Specialist referral optimization
• Preventive care performance
• Clinical quality measures

Job description

1. Provider Pod Leadership
   • Lead recurring Provider Pod meetings for assigned provider organizations.
   • Develop meeting agendas and facilitate productive discussions.
   • Coordinate participation from internal subject matter experts.
   • Track action items and ensure accountability for completion.
   • Aggregate data with the Senior Financial Analyst and the Senior Data Analyst.
     • Present findings in the POD meetings to rank-and-file providers.
2. Value-Based Performance Management
   • Lead performance reviews and action planning related to:
     • Revenue cycle optimization and issue resolution
     • Medicare STAR quality gap closure opportunities
     • Risk Adjustment Factor (RAF) optimization
     • Suspect condition validation and documentation improvement
     • HCC coding opportunities
     • Cost of care reduction initiatives
     • Emergency Department utilization
     • Hospital admissions
     • Readmission reduction
     • Specialist referral optimization
     • Preventive care performance
     • Clinical quality measures
3. Provider Relationship Management
   • Build trusted relationships with physician leaders and practice administrators.
   • Serve as the primary strategic liaison between the (provider organization / IPAs / Systems / ACOs) and the MSO.
   • Identify operational barriers impacting provider performance.
   • Coordinate internal resources to resolve provider concerns.
   • Promote adoption of MSO programs, tools, and best practices.
4. Performance Improvement
   • Analyze provider performance trends.
   • Develop action plans to improve financial and clinical outcomes.
   • Monitor progress toward established performance goals.
   • Present performance dashboards and recommendations.
5. Cross-Functional Collaboration
   • Partner with teams responsible for:
     • Revenue Cycle
     • Clinical Operations
     • Care Management
     • Coding and Documentation
     • Quality Improvement
     • Provider Contracting
     • Population Health
     • Analytics
     • Pharmacy
     • Network Operations
6. Performs all other miscellaneous responsibilities and duties as assigned or directed.

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