Tactical Activities Responsible for the implementation of tactical workplace well being plans for employer groups utilizing industry, national, and state best practices to increase employee participation and engagement. Assists in conducting training and/ or seminars for employer groups' administrators, members, leaders, and/or group decision makers at workshops and/or se

Program and Project Management Plan and implement multiple cross departmental programs and project(s) with guidance from program managers, executive sponsors, subject matter experts, and project staff. Manage deliverables and timelines. Gather business requirements to determine timelines and budgets. Conduct ongoing assessments to reprioritize as needed and to make mid co

Coordinate and monitor daily workload of MM operations staff to ensure all applicable performance standards/expectations are met. Act as primary point of contact and back up for certain tasks as assigned. Evaluate and document the accuracy of various work processes through monitoring/audits. Identify training needs and report to management. Develop, document, and communic

Program and Project Management Responsible for strategic and tactical planning of HMSA's approach to delivering excellent performance and value for Federal Plan 87 and providing clear leadership, training, guidance, and coordination to all HMSA and partner/vendor resources supporting Federal Plan 87. Responsible for managing and cultivating HMSA's relationship with OPM, a

Strategic planning and project management. Collaborate with cross functional teams to develop comprehensive marketing plans and multiplatform campaigns to engage target audiences. Contribute to the development and implementation of various marketing plans, best practices, and guidelines. Contribute to strategic marketing plans to promote HMSA's brand. Collaborate with lea

Sales Activities Meet established marketing plan goals and achieve annual sales revenue and membership growth objectives by effectively promoting and closing prospective sales opportunities. Must generate robust sales activities including self generated marketing and email campaigns, outbound calls to assigned existing lead lists. Perform quick and efficient transaction f

Design, develop and operationalize new clinical integration programs for key partners in market. Will act as primary program lead for value based deals and special provider projects. Design, develop and operationalize next generation payment models for key partners in market. Will collaborative build next gen models with key ACOs leaders / PO leaders and high value physic

Prioritizes approved invoices and check requests according to payment terms. Assist with month end accruals as needed. Familiarizes with company policies and navigating steps in Dynamics GP, Certify and CentreSuite. Verifies approver's level of authority to ensure that the cost center and the amount being charged are authorized. Validates vendor id to ensure that the appr

Serves as NCQA subject matter expert, ensures health plan compliance and support as it relates to department programs and activities. Initiate, facilitate and coordinate quality improvement activities and metrics to support assigned NCQA standards and requirements. Proactively keep all staff updated on NCQA standards and application, through notifications of change, workf

Direct and oversee all aspects of the Provider Call Center, in alignment with corporate goals and initiatives. Manages, oversees, and evaluates staff. Ensure Provider Call Center performance meets/exceeds Key Performance Indicators by evaluating, analyzing, and interpreting data and metrics. Report on or supervise reporting of KPI metrics. Ensure cross functional collabor

Manage HMSA's social media profiles and presence. Create, manage, and grow HMSA's business presence across relevant social media channels, including, but not limited to Facebook, Instagram, X (formerly Twitter), LinkedIn, Yelp, and YouTube. Evaluate new social media channels for appropriateness and integrate into the HMSA suite of social media platforms. Responsible for s

Revise and/or develop medical policies in conjunction with assigned medical director and in accordance with Development and Approval of Medical Policy administrative policy; process includes appropriate and timely implementation and publication. Support MM sponsored meetings by preparing and distributing an agenda, minutes, and documents to be discussed, and taking minute

Establishes relationships with business partners and the IT organization in order to provide technical solutions to meet user needs and influence strategic initiatives. Responsible for leading the analysis of IT requirements, alignment of IT resources and processes in order to meet the clients' organizational needs, as well as the design of enterprise solutions. Responsib

Investigator Team Leadership and Support Perform Investigator staff oversight, and coaching on day to day investigation activities including, but not limited to FWA case reviews and approvals, regulatory referrals, documentation, reporting, overpayment processing and prevention. Facilitate and lead Investigator level meetings to resolve operational issues, brainstorm FWA

Leadership Identify, initiate, and manage organization wide projects to ensure that all HMSA's Medicare Program contractual obligations are met or exceeded. Manages necessary changes to existing systems, operations or workflows to address new/revised requirements of CMS/DHS/MQD. Structures work plans and project scope to deliver business impact on high priority issues. Ad