Manager, Network Management - Provider Performance - Houston, TX
About The Position
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.
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.
- Ability to 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.
Nice To Haves
- 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.
Responsibilities
- Managing daily activities and implementing strategies to improve provider HEDIS, STARS, risk adjustment, and financial performance.
- Leading provider recruitment and contracting efforts for physicians, physician groups, and facilities, including large or complex health systems and value-based arrangements.
- Developing and negotiating contracts.
- Building and maintaining strong provider relationships.
- Ensuring strategic coverage within the assigned territory.
- Providing ongoing provider education and service.
- Managing, mentoring, and training provider support resources.
- Serving as a subject matter expert to improve efficiencies and results.
- Engaging physicians, influencing behavior change, identifying performance improvement opportunities, developing actionable plans, measuring outcomes, and adjusting strategies to achieve client goals in a value-based care environment.
Benefits
- 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
- Other incentives
- Annual incentive bonus plan
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What This Job Offers
Job Type
Full-time
Career Level
Manager
