Provider Performance Advocate

Job Summary

Hybrid Work Environment - Must reside in Hawaii
Pay Range: $53,000 to $99,000
Note: Individuals typically begin between the minimum to middle of the pay range
Works in conjunction with Integrated Health Management Services program teams, in the PCP or PO Offices, to improve provider appointment adherence, and encourage members to actively participate and engage in managing their care.
Explains designated program access and expectations to members in a clear and accurate way.

Responsibilities

• Manages patient gaps in care by establishing efficient and effective workflows between providers, patients, and HMSA.
• Accountable for establishing and maintaining sustained engagement within practices that impacts costs, quality, access, and overall patient experience through the deployment of tactical and strategic methodologies.
• Builds and effectively maintains strong relationships with practice operational and clinical leadership that informs development of performance improvement initiatives to achieve identified goals.
• Supports ongoing physician -- patient relationships by providing educational and operational support to improve the quality, access, and satisfaction of the patient experience.
• Actively conducts physician-patient outreach which may include telephonic, face-to-face or via email.
• Led ad-hoc projects/assignments and actively participate in all internal and external meetings.
• Engages with members on both inbound and outbound calls to establish trust, credibility and drive improved health and well-being.
• Provides initial engagement to member who self-refer or are referred by their physician or facility or participate in appropriate intervention.
• Utilizes effective communication skills such as motivational interviewing to gain agreement from member to be compliant with routine provider appointments, recommended screenings, vaccinations, etc.
• Collaborates with physicians, office staff, and HMSA team members to address and/or close gaps in care.
• Affordably assesses and communicates provider capabilities to inform future interventions; work with the HMSA LOB PO teams as needed.
• Uses internal and external data to analyze and interpret trends. Works with appropriate stakeholders to implement proactive strategies to address issues and measure impact.
• Develops and deploys localized practice optimization strategies based on data analysis that includes measurable and time-specific aim statements as part of a data-informed PDSA rapid cycle optimization approach.
• Functions as a change agent by promoting workflow efficiencies, best practices, and other change management tactics that improve patient-centered care, timely access to care, and population health management.
• Facilitates communication and requests among multi-disciplinary team members, providers, health plan, and members.
• Coordinates data extracts and data analysis interpretation in preparation of reports aimed to determine the effectiveness of programs for the assigned PO/providers.
• Develops and deploys workflow optimization and training efforts for provider office staff in a changing and evolving healthcare operating environment.
• This position requires high level of autonomy in decision making.
• Maintains a deep understanding of HMSA performance measure requirements.
• Performs all other miscellaneous responsibilities and duties as assigned or directed.

Qualifications

• Bachelor's degree and two years of related medical experience; or equivalent combination of education and related work experience.
• Effective communication skills (with members, colleagues, physicians, and plan representatives). Includes active listening skills to determine needs and identify problems.
• Demonstrated ability to solve practical problems with a variety of variables.
• Basic working knowledge of digital/electronic medical records and related documentation.
• Intermediate working knowledge of Microsoft Office applications. Including but not limited to Word, Excel, and Outlook/email.
• Must have valid driver's license, access to an automobile with current license, registration, and no-fault insurance.