Manager, Network Management - Provider Performance - Houston, TX

Health Care Service Corp.; Houston (TX); Hybrid; USD 93,000 - 168,000; Full time

Job summary

Health Care Service Corporation (HCSC) is seeking a senior leader to manage provider performance and contracting strategies across physicians, physician groups, and facilities in a value-based care environment. You will lead a team, negotiate contracts, enhance HEDIS/STARS outcomes, and drive financial performance while building strong provider relationships.

This role requires deep knowledge of provider contracting, a consultative, data-driven approach, and the ability to travel within the

Qualifications

• Bachelor Degree and 5 years provider contracting experience OR 9 years managed care experience including 5 years provider contracting.
• Extensive knowledge of provider and facility contracting, products, and claims/processing systems.
• Leadership skills to oversee staff, implement initiatives, and work across the company to resolve issues.
• Negotiation skills.
• Relationship building skills.
• Knowledge of marketplace.
• Meet deadlines and work well under pressure.
• Verbal and written communication skills to interact with all levels of corporate personnel and providers.
• PC proficiency to include Microsoft Office.
• Analytical skills.
• Project management skills to lead or participate in projects or initiatives.
• Ability and willingness to travel within assigned areas of responsibility, including overnight stays.

Responsibilities

• Lead and mentor a team of Provider Performance Network Operations Consultants.
• Develop and negotiate contracts for physicians, physician groups, and facilities, including large health systems.
• Improve provider HEDIS, STARS, risk adjustment, and financial performance through data-driven strategies.

Skills

Leadership skills

Negotiation skills

Relationship building

Analytical skills

Project management

Travel willingness

Education

Bachelor Degree in relevant field

9 years managed care experience including 5 years provider contracting

Tools

Microsoft Office

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

This position is responsible for managing daily activities and implementing strategies to improve provider HEDIS, STARS, risk adjustment, and financial performance while leading provider recruitment and contracting efforts for physicians, physician groups, and facilities, including large or complex health systems and value-based arrangements. The role develops and negotiates contracts, builds and maintains strong provider relationships, ensures strategic coverage within the assigned territory, and provides ongoing provider education and service. Leading a team of Provider Performance Network Operations Consultants, this individual is responsible for the management, mentoring, and training of provider support resources while serving as a subject matter expert to improve efficiencies and results. Success in this role requires a consultative, data-driven leader who can engage physicians, influence behavior change, identify performance improvement opportunities, develop actionable plans, measure outcomes, and adjust strategies to achieve client goals in a value-based care environment.

JOB REQUIREMENTS

• Bachelor Degree and 5 years provider contracting experience OR 9 years managed care experience including 5 years provider contracting experience.
• Extensive knowledge of provider and facility contracting, products, and claims/processing systems.
• Leadership skills to oversee staff, implement initiatives, and work across the company to resolve issues.
• Negotiation skills.
• Relationship building skills.
• Knowledge of marketplace.
• Meet deadlines and work well under pressure.
• Verbal and written communication skills to interact with all levels of corporate personnel and providers.
• PC proficiency to include Microsoft Office.
• Analytical skills.
• Project management skills to lead or participate in projects or initiatives.
• Ability and willingness to travel within assigned areas of responsibility, including overnight stays.

PREFERRED REQUIREMENTS

• Previous HEDIS and/or CMS STARs experience.
• Solid understanding of health insurance, customer messaging/design and project management.
• Expert level of Excel preferred (knowledge of pivot tables, VLOOKUP, etc.).
• Experience in financial/trend analysis.
• Team player with proven ability to foster and manage working relationships within a matrix environment to obtain buy-in and drive results.

ADDITIONAL DETAILS

Client-site Location: This is a field based position in the Houston market. The individual will be onsite at provider offices typically 3 days a week and work from home 2 days a week.

Schedule: Monday - Friday, typical business hours with infrequent evening and weekend meetings.

Sponsorship: Sponsorship is not available.

Pay Transparency Statement: At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

Base Pay Range $92,700.00 - $167,500.00 Exact compensation may vary based on skills, experience, and location.

HCSC Employment Statement: We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

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For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren’t afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace.

Learn more about HCSC, our commitment to our members and the opportunity you’ll have to improve health care delivery in an open, collaborative environment.

HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants. If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1-866-977-7378 to request reasonable accommodations. Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process.

Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas, Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association © Copyright 2025 Health Care Service Corporation. All Rights Reserved.