Network Management Consultant - Provider Performance - Houston, TX
About The Position
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.
Requirements
- 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
Nice To Haves
- 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.
Responsibilities
- Supporting HEDIS, STARS and financial provider performance and contracting activities
- Ensuring strategic provider coverage within an assigned territory
- Contract negotiations for physicians, physician groups, and small to mid-size hospitals
- Providing support for more complex hospital and physician contracting initiatives
- Developing and maintaining strong provider relationships
- Delivering ongoing provider education and service
- Serving as a trusted partner to drive HEDIS, STARS, risk adjustment, and value-based care performance
- Engaging providers
- Identifying performance improvement opportunities
- Developing and executing action plans
- Leveraging analytics to influence outcomes
- Adapting strategies to achieve client goals
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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
