Remote Provider Network Management Jobs in Texas

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Job SummaryThis position is responsible for directing a team for a specific region accountable for professional provider contracting and facility contracting as well as provider relations and value based care program implementation. This position is accountable for the development, implementation and management of network strategies including maintaining and improving current provider networks, developing new networks, achieving unit price targets, managing medical cost trend, and educating providers. Accountable for Network Management which includes Group, Government and Retail programs. This position is responsible for ensuring contracted network coverage and for oversight of management and staff who manage contracting operations.

Job Responsibilities:

1. Develop and manage provider contracting and servicing strategies as well as value based care programs for a specific region.
2. Accountable for the maintenance, development, negotiation and successful completion of provider network participation contracts. Ensure appropriate coverage of networks for locations.
3. Oversee the contracting operations for professional providers and hospitals, for group, government and retail programs.
4. Achieve competitive advantage in discounts and access through contract negotiations and effective relationship management.
5. Develop strategies, draft agreements and negotiate contracts for newly recognized categories of providers.
6. Oversee the analysis and reporting required to develop payment strategies and take corrective action as needed.
7. Accountable for resolution of issues and contractual disputes.
8. Ensure staff meets/exceeds goals, objectives and initiatives. Ensure staff is trained, positions are filled, and employees receive communications on changes, etc.
9. Accountable for budget, operational reporting and financial reporting.
10. Maintain effective communications and provide support to regional counterparts in sales, marketing, and account management.
11. Communicate and interact effectively and professionally with co-workers, management, customers, etc.
12. Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
13. Maintain complete confidentiality of company related business.
14. Maintain effective communication with Vice President, Network Management regarding developments within areas of assigned responsibilities and perform special projects as required or requested.

JOB REQUIREMENTS:
* Bachelor degree and 7 years experience in health care/insurance administration, hospital/health care contracting, and hospital/physician relations.
* 5 years management experience at a director level including assisting in or responsible for development of strategies and initiatives.
* Knowledge of hospital and provider reimbursement strategies and policies.
* Clear and concise verbal and written communications skills including interpersonal skills to represent company to external entities, negotiate contracts, resolve issues, and prepare executive and employee presentations.
* Leadership skills, team player, relationship building skills.
* Experience working in a fast paced environment and meeting deadlines.
* Accuracy and sound judgment with regard to financial matters such as contract performance and impact.
* Negotiation skills. Experience negotiating large, complex hospital and physician group contracts.
* Ability and willingness to travel.

*Overseeing the annual budget and allocating resources for various projects and operational needs.

*Translating needs and initiatives into compelling business cases.

*Conducting cost-benefit analyses to justify investments and ensure ROI

PREFERRED JOB REQUIREMENTS:
* MBA or Masters in Health Administration.

*Please note: This is a Telecommute (Remote) role. Remote employees must live within the continental United States, excluding Alaska, California, Hawaii or New York. Sponsorship is not available

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

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 plansubject to the terms and the conditions of the plan.

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$161,500.00 - $299,700.00

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