Network Management Consultant - Provider Performance - Houston, TX

Health Care Service Corp.; Houston (TX); Hybrid; USD 56,000 - 124,000; Full time

Benefits offered by this job

Health and wellness benefits

401(k) savings plan

Pension plan

Paid time off

Parental leave

Disability insurance

Supplemental life insurance

Employee assistance program

Paid holidays

Tuition reimbursement

Plus other incentives

Job summary

Health Care Service Corporation is seeking a provider contracts and performance professional to support HEDIS, STARS, and financial provider initiatives in a Houston-area territory. You will negotiate physician and hospital contracts, build strong provider relationships, and drive value-based care through data-driven strategies.

The role requires travel within the territory, including overnight stays, and offers a collaborative, development-focused environment with opportunities for professional

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.

Responsibilities

• Support HEDIS, STARS and financial provider performance and contracting activities to ensure strategic provider coverage within an assigned territory.
• Develop and maintain strong provider relationships and deliver ongoing education and service.
• Negotiate contracts for physicians, physician groups and hospitals of varying sizes.
• Leverage analytics to identify performance improvement opportunities and execute action plans.

Skills

Contract negotiation

Provider relationships

Analytical skills

Travel willingness

Microsoft Office

Verbal & written communication

Deadline-driven

Education

Bachelor degree

Bachelor degree in Business

Tools

EMRs

Population health tools

Excel

PHI handling HIPAA

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 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.

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.

• 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

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.

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.