Manager, Network Management - Provider Performance - Houston, TX

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

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

$92,700.00 - $167,500.00

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