This position serves as the principle HMSA contact point in
facilitating the assigned Hospital/Health System (Provider) and/or
broader provider network activities for all lines of business. This
position will be responsible for the successful coordination and
facilitation of all touch points between HMSA and Provider, as a
client and service organization, along with the achievement,
improvement and maintenance of HMSA's strategic goals. This
involves knowledge and ability including implementation and
administration of all the contractual relationships, financial
models and HMSA business matters with the Provider.
This position utilizes innovative way to explores and nurtures
improvement opportunities, guides provider partner to gain insights
into their organization/health care delivery system. Through data
analysis, monitoring performance against metrics, interpersonal
skills, and leading an integrated, collaborative service team
consisting of internal and external partners, this position will
implement a Provider-centric plan to achieve our mutual goals to
provide our members with quality care and continue to build a
sustainable health care model. This requires extensive knowledge of
the health care industry and applying new foundational principles
as the knowledge base for cost effective quality improvement.
Job is required to work primarily from home or in a mobile
office environment and infrequently at various unassigned
workstations located throughout applicable HMSA department(s)
mainly for in-person and on-site meetings with internal contacts.
Parking validation will be provided on an occasional and transitory
basis for approved business needs.
Exempt or Non-Exempt
Bachelor's Degree and five years related work experience; or
equivalent combination of education and related work
Must have valid driver's license, access to an automobile with
current license, registration and no fault insurance.
Requires safely operating an insured automobile for travel to
off-site locations to conduct and accomplish business related
Excellent verbal, written, presentation and group facilitation
Strong critical thinking skills.
Effective leadership and project management skills.
Strong research, development and implementation skills.
Duties and Responsibilities Works closely with the Provider to
develop, implement and maintain strategic initiatives to deliver
quality care, improved access for HMSA members and to build a
sustainable health care system by bending the cost trend across all
lines of business.
Collaborate in setting the strategic direction for the business
relationship between HMSA and Provider.
Utilize the quality improvement principles and subsequent
related high-leverage changes in supporting the Provider in
establishing its overall improvement aim and tests of change.
Assess, document, and report progression of assigned Provider
from both a quantitative and a qualitative perspective.
Coordinate with HMSA Integrated Health Management Services and
other Provider Service team members to develop and carry out action
plans with provider integrated service teams to achieve defined
goals and complete deliverables.
Lead efficient, effective collaborative meetings with the
executive leadership of the Provider and HMSA stakeholders. Manage
all aspects of the provider relationship to include management of
hospital quality programs, payment transformation and other
strategic initiatives. Role model these skills in order that
improvement team leaders will also be able to effectively manage
improvement team meetings with increasing independence over the
course of time.
Identify available external resources, such as consultants and
group learning opportunities, to meet specific needs which extend
beyond those that are met by the Provider Network and develop
arrangements, working with HSD/PS Leadership and other functional
areas within HMSA to make such resources available to all PO's.
Support provider team members in ongoing education on innovative
principles and interventions in the health care to improve cost,
quality, access and health.
Lead service teams in support of the on-going relationship with
Provides effective and actionable market intelligence with
regard to the health care community.
Plan and implement multi-level, cross departmental programs and
projects with guidance from executive sponsors and subject matter
experts. Manage deliverables and timelines including gathering
business requirements, research and analysis and ongoing
assessment. Assemble and lead teams composed of participants in
HMSA and other HMSA partners to support the strategic initiative.
Regularly work with data analysts to conduct analysis of clinical
data, including medical claims, Electronic Medical Record data and
utilization data to identify trends. Translate findings and
outcomes and recommend strategies for early intervention and
health/disease management, new programs, workflow and operational
improvement activities. Assist clinic in facilitating changes and
improvements based on the data.
Establish, implement and revise all strategies to achieve cost,
quality, health and access goals. Ensure reviewed and updated as
necessary. Participate in contract negotiations and development of
goals and deliverables.
Work with HMSA management, HMSA Medical Director and other HMSA
staff and external partners to ensure that Provider meets goals and
standards. Effectively and actively manage and direct
prioritization and resolution of all issues related to Provider in
a timely manner effectively and collaboratively working through all
functions and levels of HMSA. This is not simply acting as a
pass-through but requires active engagement when necessary.
Maintain collegial relationships with internal cross-functional
teams and external partners including, but not limited to,
collaborating organizations and vendors.
Assist with the development and management of the annual unit
plans and budgets.
Equal Opportunity Employer - Minorities/Women/Protected
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