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Senior Manager, Clinical Integration

HMSA • Honolulu, HI, United States • $200k - $250k / year • 1m ago

Strategic Partnerships & Strategy Execution
- Collaborates with CI executives, HMSA leadership and Provider leadership in setting the strategic direction for the partnership, as well as developing and executing short and long-term population health strategies that align with the respective Value-Based Payment Agreements.
- Operationalizes new clinical and financial models and programs with health system stakeholders, demonstrating shared commitment and collaborative action to drive affordability and improve quality and health outcomes.
- Leads and/or supports all active HMSA/Provider workgroups as established by the Joint Value-Based Governance Committee, to support integration efforts and design/implement transformational population health initiatives.
- 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.
- Develops and manages project plans to ensure effective, timely execution of programs/deliverables to meet partnership and value-based payment contractual objectives.
- Maintains clear documentation from subcommittees to ensure alignment, timely follow through, and effective communication of next steps.
- Utilizes the quality improvement principles and subsequent related high-leverage changes in supporting the Provider in establishing its overall improvement aim and tests of change.
Engagement & Facilitation
- Leads change management efforts by effectively engaging and influencing key stakeholders from across HMSA and Provider Partners to redesign programs and streamline/integrate key health plan and delivery functions.
- Leads internal matrixed teams across HMSA to drive clinical transformation work and supports ongoing provider partnership efforts including contracting and issues resolution.
- Partners with other CI teams to share information from respective provider partnerships and VBP experiences to scale across other network provider systems/partners; and supports design/implementation of other Value-Based programs.
- Plans and implements multi-level, cross departmental programs, and projects with guidance from executive sponsors and subject matter experts.
- Manages project plans, deliverables, and timelines including gathering business requirements, research and analysis and ongoing assessment.
- Leads 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 value-based agreements, clinical integration, population health, hospital quality programs, payment transformation and other strategic initiatives.
- Establishes, implements, and revises all strategies to achieve cost, quality, health, and access goals. Participates in contract negotiations and development of goals and deliverables.
- Supports provider team members in ongoing education on innovative principles and interventions in the health care to improve cost, quality, access, and health.
- Leads service teams in support of the on-going relationship with the Provider.
- Provides effective and actionable market intelligence about the health care community.
Strategic Analyses
- Implements and presents value-based care dashboards with key performance metrics to ensure the CI strategy achieves its intended outcomes within prescribed timeframes.
- Presents status updates on strategic partnership, VBP performance and progress to HMSA and health system leadership.
- Oversees reporting and tracking capabilities to monitor overall financial performance on the VBP agreement, as well as program level outcomes reporting.
- Manages data and analytics needs for clinical integration to effectively support bi-directional exchange of information between HMSA and health system.
- Develops opportunity assessments, business development proformas, and presents in-depth analyses to inform HMSA strategies and VBC interventions.
- Translates findings and outcomes and recommends 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.
Leader Responsibilities
- Direct managers, supervisors, and staff in assignment of projects and work, performance monitoring, recruitment and career development, and training and employee development. Adjusts processes for both operational and strategic activities that are related to procedures, workflows, requirements, and other business activity that impacts members, providers, employee productivity and morale.
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.
Performs all other miscellaneous responsibilities and duties as assigned or directed.

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