Provider Performance Advocate at HMSA

Honolulu, Hawaii, United States -

Full Time

Start Date

Immediate

Expiry Date

31 Aug, 26

Salary

0.0

Posted On

02 Jun, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Provider Engagement, Relationship Building, Patient Care Coordination, Motivational Interviewing, Process Improvement, Data Analysis, Change Management, Electronic Medical Records, Microsoft Office, Population Health Management, Problem Solving, Communication Skills

Industry

Insurance

Description

1. Provider Practice Engagement & Communication and Relationship Building * 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. * Build and effectively maintain 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. Includes the development and delivery of a streamlined process for the practice to access additional educational and behavioral change tools, as appropriate. * Actively conducts physician-patient outreach which may include telephonic, face-to-face or via email. * Leads ad-hoc projects/assignments and actively participate in all internal and external meetings. 2. Member Engagement * 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. * Utilize effective communication skills such as motivational interviewing to gain agreement from member to be compliant with routine provider appointments, recommended screenings, vaccinations, etc. * Collaborate with physicians, office staff, and HMSA team members to address and/or close gaps in care. 3. Problem Solving and Process Improvement * Assess and communicate provider capabilities to inform future interventions; work with the HMSA LOB PO teams as needed. * Use internal and external data to analyze and interpret trends. Work with appropriate stakeholders to implement proactive strategies to address issues and measure impact. * Develop and deploy 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. * Function 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. 4. Performs all other miscellaneous responsibilities and duties as assigned or directed. * This may include projects and pilots that align with HMSA corporate goals, and internal and external metrics and deliverables, including employer groups, business partners, and CMS. For example: * HMSA-IHMS-MOC assignments, training, meetings, and events * Employer group pilot programs and health fairs * Care coordination and care gap closure as identified through various projects and pilots. * Medical record and/or clinical data collection #LI-Hybrid Qualifications 1. Bachelor's degree and two years of related medical experience; or equivalent combination of education and related work experience. 2. Effective communication skills (with members, colleagues, physicians, and plan representatives). Includes active listening skills to determine needs and identify problems. 3. Demonstrated ability to solve practical problems with a variety of variables. 4. Basic working knowledge of digital/electronic medical records and related documentation. 5. Basic working knowledge of Microsoft Office PowerPoint. 6. Intermediate working knowledge of Microsoft Office applications. Including but not limited to Word, Excel, and Outlook/email. 7. Must have valid driver's license, access to an automobile with current license, registration, and no-fault insurance.

Responsibilities

The role focuses on managing patient gaps in care by building strong relationships between providers, patients, and the health plan. It involves implementing performance improvement initiatives and utilizing data to optimize practice workflows and member health outcomes.