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. These activities include:
- Enforce compliance with the contractual SLAs and deliverables.
- Review and validate performance reporting.
- Capture potential value leakage and/or service level penalties.
- Coordinate 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.

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Manager, Provider Performance Management at HMSA

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