Provider Engagement Manager

United States·Hmsa Bldg-Hms-Oahms - HonoluluNormalmid

Engagement ManagerProject & Program Management

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Quick Summary

Overview

Provider Pod Leadership Lead recurring Provider Pod meetings for assigned provider organizations. Develop meeting agendas and facilitate productive discussions.

Technical Tools

Engagement ManagerProject & Program Management

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.
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
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.
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.
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
Performs all other miscellaneous responsibilities and duties as assigned or directed.

#LI-Hybrid

Bachelor's degree and three years of related experience; or an equivalent combination of education and work experience.
Experience facilitating leadership and sr. leadership meetings.
Strong knowledge of healthcare reimbursement models.
Two years of leadership experience.