What are the responsibilities and job description for the Clinical Integration Manager position at HMSA?
- Supports strategic relationships and execution under the direction of the Sr. Manger of Clinical Integration and CI executives.
- Assists with the short and long-term design and execution of population health strategies that transition from fee-for-service models to value-based payment agreements.
- Supports the operationalizing of new clinical and financial models/programs with Providers, demonstrating shared commitment and collaborative action.
- Monitors the progress and timely issue resolution of contractual performance measures, as well as the proactive, early identification of potential issues for joint awareness and action.
- Engage with internal matrixed teams across HMSA to support value-based agreements and clinical transformation work.
- 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.
- Supports positive engagement and facilitation
- Actively promotes a positive and structured environment for effective stakeholder engagement between HMSA and Provider leadership in governance, sub-committee and subject-matter expert sessions. This includes agenda-setting, internal preparations and generating pre-read/presentation materials.
- Participates in contract negotiations to support timely tracking, follow-up and finalization.
- Manage all aspects of the day-to-day Provider relationship to include involvement in hospital quality programs, payment transformation, and major issue resolution on payer activities such as claims processing, chargemaster changes, rate updates/inquiries and credentialing delays.
- Supports internal teams and external stakeholders in drawing connections between analytics and observations to improve quality, access and health outcomes while reducing cost. Ability to create presentation materials for sharing insights, developing action plans and achieving buy-in at all levels.
- Works with HMSA management, HMSA Medical Director and other HMSA staff and external partners to ensure that Provider meets goals and standards. Effectively and actively manages and direct prioritization and resolution of all issues related to Provider in a timely manner through all functions and levels of HMSA. This is not simply acting as a pass-through but requires active engagement when necessary.
- Cross-trains and role models these essential duties so other team members can contribute with increasing independence over the course of time.
- Other Duties/Functions
- 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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