Network Management Consultant - Provider Performance - Houston, TX

HCSC Group; Houston (TX); Presencial; USD 56.000 - 124.000; Jornada completa

Descripción de la vacante

Health Care Service Corporation (HCSC) is seeking a contract and provider performance specialist to support HEDIS, STARS and financial contracting within an assigned territory, aligning provider coverage with client goals and regulatory requirements.

The role emphasizes negotiation, analytics, and education of providers, as well as building trusted relationships to drive performance improvements in a rapidly evolving healthcare environment. Travel to provider sites is required.

Formación

• Bachelor's degree required; or 5 years managed care ops with contract experience.
• Strong negotiation and relationship-building abilities.
• Ability to travel within assigned territory, including overnights.

Responsabilidades

• Support HEDIS, STARS and financial provider performance initiatives.
• Negotiate contracts for physicians, groups, and hospitals.
• Develop and execute action plans using data analytics to influence outcomes.
• Educate providers and maintain strong provider relationships.
• Travel within territory as required.

Conocimientos

Contract negotiation

Analytical thinking

Verbal & written communication

Travel readiness

Educación

Bachelor Degree

Descripción del empleo

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 supporting HEDIS, STARS and financial provider performance and contracting activities to ensure strategic provider coverage within an assigned territory, including contract negotiations for physicians, physician groups, and small to mid-size hospitals, while providing support for more complex hospital and physician contracting initiatives. The role develops and maintains strong provider relationships, delivers ongoing provider education and service, and serves as a trusted partner to drive HEDIS, STARS, risk adjustment, and value-based care performance. Success in this role requires a consultative, data-driven professional who can engage providers, identify performance improvement opportunities, develop and execute action plans, leverage analytics to influence outcomes, and adapt strategies to achieve client goals in a rapidly evolving healthcare environment. Ability and willingness to travel within the assigned territory, including overnight stays, is required.

Required Job Qualifications:

• Bachelor Degree and at least one year experience developing and negotiating provider contracts OR 5 years managed care operations experience handling independent work with at least one year experience developing and negotiating provider contracts.
• Meet deadlines and work well under pressure.
• Verbal and written communication skills, organizational and planning skills.
• PC proficiency to include Microsoft Office.
• Analytical skills.
• Ability and willingness to travel within assigned territory, including overnight stays

Preferred Job Qualifications:

• Bachelor Degree in Business.
• 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.
• Experience with EMRs and population health tools, including provider outreach to facilitate access, retrieval of medical records and chart notes, and compliant handling of Protected Health Information (PHI) in accordance with HIPAA requirements.

ADDITIONAL DETAILS:

• Client-site Location: This is a field based position in the Houston market. The individual will be onsite at provider offices up to 3 days a week and work from home typically 2 days a week.
• Schedule: Monday - Friday, typical business hours with infrequent evening and weekend meetings.
• Sponsorship: Sponsorship is not available

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

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. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

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.

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.

Base Pay Range

$55,900.00 - $123,500.00

Exact compensation may vary based on skills, experience, and location.