Network Management Consultant - Provider Performance - Houston, TX

HCSC Group; United States; Hybrid; USD 63,000 - 114,000; Full time

Job summary

Health Care Service Corporation (HCSC) is seeking a Provider Contracts Specialist to support HEDIS, STARS and financial provider performance within a defined territory. The role includes contract negotiations for physicians, physician groups, and hospitals, while building strong provider relationships and delivering education and service to drive performance in a rapidly evolving healthcare environment.

The candidate must be able to travel within the territory, including overnight stays, and

Qualifications

• Bachelor degree and at least 1 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 in the territory.
• Develop and maintain strong provider relationships and deliver ongoing provider education and service.
• Drive HEDIS, STARS, risk adjustment and value-based care performance through data-driven actions.
• Engage providers with data-driven insights to improve outcomes and achieve client goals while traveling within the territory.

Skills

Verbal communication

Written communication

Organizational skills

Planning skills

Analytical skills

PC proficiency

Willingness to travel

Education

Bachelor's degree

Tools

Microsoft Office

EMRs

Population health tools

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. 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.

This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii.

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. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law.

Base Pay Range

$63,300.00 - $114,300.00

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