Manager, Provider Performance Management

Job Summary

Hybrid Work Environment - Must reside on Oahu
Pay Range: $68,000 to $133,000
Note: Individuals typically begin between the minimum to middle of the pay range

Minimum 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.

Duties And 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.
• Cookordination 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.