Payor Contracting Jobs in Hawaii (NOW HIRING)

Job Summary:

East Hawaii Region of Hawaii Health Systems Corporation is seeking a dynamic and experienced Regional Medical Staff Services Administrator to lead and manage the operations of the Medical Staff Services department. This department head position involves overseeing the operational function of the Medical Staff Department including credentialing, payor enrollment, peer review, and ensuring compliance with all relevant regulations and standards. The ideal candidate will have a strong background in medical staff services best practices and initiatives that enhance the overall provider experience.

The Medical Staff Services Department supports a medical staff of approximately 600 physicians, nurse practitioners and physician assistants across 33 specialties who provide services at Hilo Benioff Medical Center, Honoka''a Hospital, Ka'u Hospital and Yukio Okutsu State Veterans Home. This is a newly established position that will report to the Regional Chief Human Resources Officer and the Regional Chief Executive Physician.

Location: Must be on-site when hired to meet operational requirements.

Essential Job Functions:

• Provides strategic leadership and oversight in credentialing, privileging and payor enrollment, document management, OPPE and medical staff quality monitoring, policy review, quality interface of all Medical Staff, ensuring compliance with internal and external policies and legal/regulatory requirements.
• Directs all actions related to Medical Staff applicants initial eligibility for membership and participation.
• Leads the preparation, documentation, agendas, policies, and meeting packets for Medical Executive Committee meeting and serves as a key advisor by attending all meetings in person.
• Manages all incident agreement and routes them to the appropriate parties in accordance with established service level agreement (SLA).
• Facilitate and participates in highly confidential peer-to-peer review meeting, overseeing the process, and attend meetings in person.
• Evaluate, implements, and optimizes software, systems, and technical solutions to optimize credentialing, payor enrollment and related workflows.
• Develops and updates applicable governing documents including bylaws and credentialing policies that support and direct organizational best practices and ensure compliance.
• Recognizes, investigates, and validates discrepancies and adverse information obtained.
• Builds, strengthens, and maintains strategic relationships with internal and external stakeholders, including Human Resources, Employee Health, Organizational Development, Contracting, Information Technology, and Payor Enrollment, to support effective decision-making, coordinated workflows, and alignment of Medical Staff functions across the Region.
• Collaborates with physician leaders to develop and maintain a region-specific criteria-based clinical privileging system in accordance with regulatory requirements, accreditation standard, and organizational policies.
• Ensures the integrity, accuracy, and maintenance of all provider information in CAQH and other payor portals.
• Leads continuous improvement initiatives using best practices, data insights, and technology to optimize workflows and strengthen departmental capabilities.
• Provides strategic direction and oversight of Medical Staff Services communication, including informational newsletters, educational documents, memo.
• Manages Medical Staff Services department, including performance management, budgeting and day-to-day supervisor.
• Other duties as assigned by management.

Qualifications:

Experience:

• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certifications are required within 12 months of employment.

Experience:

• Minimum of 10 years of healthcare experience in the medical staff services field, including 5 years in leadership (preferably director level).

Education:

• Bachelor’s degree preferred.

Skills

• Ability to maintain a high level of confidentiality.
• Ability to analyze and interpret complex data with the end goal of presenting and creating tactical plans. Organizes information and data to identify and explain trends, problems and their causes.
• Ability to organize work, create priorities, strategic plans, and develop SMART goals.
• Excellent communication skills, both written and oral.
• Excellent interpersonal skills. Exhibits confidence and professional diplomacy while identifying, organizing, facilitating, and sustaining mutually-beneficial partnerships and alliances with people at all levels of the organization.
• Ability to gain cooperation and support, resolve differences, and reach compromises with others.
• Working knowledge and expertise in MDStaff and MDStat.
• Demonstrated knowledge and understanding of concepts, key functions, terminology, and work products of risk management, finance, clinical competence evaluation, and management theories.

Revised: 05/04/2026

East Hawaii Medical Group (EHMG), an affiliate of the East Hawaii Region of Hawaii Health Systems Corporation, is dedicated to advancing high-quality, patient-centered care throughout East Hawaii. Serving Hilo Benioff Medical Center, Honokaʻa Hospital, Ka'u Hospital, and the Yukio Okutsu State Veterans Home, EHMG ensures that providers are equipped to deliver exceptional care to our island communities.

Established with our mission to improve the health and well-being of East Hawaii, EHMG's administrative teams play a critical role in strengthening provider operations, optimizing workflows, and enabling sustainable, high-quality patient care across the region.

• Medical, dental and vision coverage for employee and your dependents
• 20 days (160 hours) Paid Time Off (PTO)
• 13 paid holidays each year (104 hours); 14 (112 hours) during election years
• Eligibility to participate in 401(K) with match after three months of service
• * Rates listed for paid holidays and PTO days are for 1.0 Full Time Equivalent (FTE) positions assigned to 8 hour shifts. Accruals for these benefits are otherwise prorated based on FTE.
• Loan repayment options available

Relocation Assistance is available for this position.

Hilo is located on the east side of the island of Hawaii, and has a quaint, old-Hawaii, small town atmosphere. Our island offers amazing rainforests, waterfalls and beaches. The hospital staff is community-oriented and strive to provide competent and compassionate care to every patient that enters our doors. The area is home to the Hawaii Community College, University of Hawaii, Hawaii Volcanoes National Park, excellent schools and convenient shopping.

As part of the recruiting process for this position, external applicants (job applicants NOT employed by HHSC’s East Hawaii Region) are required to complete pre-employment assessments shortly after application submission. If you are not an employee of the East Hawaii Region of HHSC, you will receive an email containing assessment instructions. We ask that you complete the assessments within two days of receipt of the request.

Offers of employment will be contingent on successfully passing a pre-employment examination, which includes a drug screen and other regulatory medical requirements such as, but not limited to, a tuberculosis (TB) screen. The cost for drug screening and blood draw for QuantiFERON and Titers, shall be borne by the Hawaii Health Systems Corporation.

The East Hawaii Medical Group is a drug-free workplace, an Equal Opportunity Employer, and conducts employment verification through E-Verify.