Provider Network & Performance Manager (HEDIS/STARs)

Medicare; Houston (TX); Hybrid; USD 93,000 - 168,000; Full time

Job summary

HCSC is seeking a leader to manage provider contracting initiatives, improving HEDIS, STARS, risk adjustment, and financial outcomes. You will head recruitment and contracting for physicians, groups, and facilities, including large systems and value-based arrangements.

You will lead a team of Provider Performance Network Operations Consultants, mentoring staff and driving data-driven improvements by engaging physicians and stakeholders.

Qualifications

• Bachelor degree with 5 years provider contracting experience or 9 years managed care with 5 years provider contracting.
• Extensive knowledge of provider and facility contracting, products, and claims/processing systems.
• Leadership to oversee staff, initiatives, and cross-functional issues.
• Negotiation and relationship-building skills.
• Analytical thinker with strong project management and travel willingness.

Responsibilities

• Manage daily activities and implement strategies to improve provider HEDIS, STARS, risk adjustment, and financial performance.
• Lead provider recruitment and contracting for physicians, groups, and facilities, including large health systems.
• Develop contracts, build provider relationships, educate and service providers, and mentor the team.

Skills

Provider contracting

Leadership

Negotiation

Relationship building

Analytical skills

Project management

Travel flexibility

Verbal/written communication

Microsoft Office

Education

Bachelor Degree

Tools

Excel

Microsoft Office

Job description

HCSC is seeking a leader to manage provider contracting initiatives, improving HEDIS, STARS, risk adjustment, and financial outcomes. You will head recruitment and contracting for physicians, groups, and facilities, including large systems and value-based arrangements.

You will lead a team of Provider Performance Network Operations Consultants, mentoring staff and driving data-driven improvements by engaging physicians and stakeholders.