Full-Time

Director Network Management

Confirmed live in the last 24 hours

HCSC

HCSC

Health insurance provider in multiple states

Financial Services
Healthcare

Compensation Overview

$115.9k - $215.4kAnnually

Senior, Expert

Austin, TX, USA + 2 more

More locations: San Antonio, TX, USA | Richardson, TX, USA

Category
Management Consulting
Consulting
Required Skills
Data Analysis
Requirements
  • Bachelor Degree and 10 years health care or health insurance experience to include 4 years contract administration and facility or provider relations experience OR 14 years of health care or health insurance experience to include 4 years contract administration and facility or provider relations experience.
  • 4 years management experience including hiring, performance management, change management and professional development.
  • Leadership skills.
  • Financial acumen, experience with oversight of budget, and experience with financial managed care contracting.
  • Knowledge of facility/provider contracting methodologies and pricing strategies and the facility or provider community.
  • Presentation skills.
  • Negotiation, contracting skills and analytical and strategic thinking skills.
  • Verbal and written communication skills.
Responsibilities
  • Direct and manage a staff of management, professional and support personnel responsible for contracting, data base and reporting who are engaged in the recruiting, contracting, educating and maintenance of a cost effective statewide network of facilities and providers.
  • Assist in the development of facility and provider strategies, direct the implementation of strategies and initiatives, and ensure attainment of goals.
  • Oversee maintenance of broad statewide managed care networks.
  • Directly handle or 'close' contracts on special or large contracts.
  • Develop plans and recommend the solutions for dealing with issues with significant impact on the business to Senior Leadership.
  • Work closely with Sales and the Data Analysis and Reporting team to assess the competitive position of the networks.
  • Maintain and further develop cooperative working relationship with other HCSC areas such as SSD, ITG, Credentialing and EHCM.
  • Responsible for leadership of the facility and provider network groups.
  • Develop and monitor an effective communication/training program to keep contracting representatives apprised of new/additional servicing responsibilities.
  • Responsible for Quality Improvement Programs to ensure all facility/provider agreements, policies and processes comply with state regulations, corporate standards, legislative mandates and accreditation/federal guidelines.
  • Oversees the development and production of communication materials for facilities/providers and facility/provider directories.
  • Participate with financial strategy committee in the assessment of network results as related to cost and utilization.
  • Responsible for department responding to facility/provider inquiries in an effective and timely manner.
  • Analyze monthly activity reports, budget and variance reports and formulate resolutions for problem trends.
  • Responsible for meeting with largest accounts periodically to hear their perspectives, respond to their issues and to exchange ideas concerning the provider network.
  • Responsible for Request for Proposals, BCBSA surveys, and national inquiries regarding network status.
  • May lead committees or participate in internal and external committees.
  • Communicate and interact effectively and professionally with co-workers, management, customers, etc.
  • Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
  • Maintain complete confidentiality of company business.
  • Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

HCSC provides health insurance services across five states: Illinois, Montana, New Mexico, Oklahoma, and Texas. The company offers a variety of health insurance plans designed for individuals, families, and businesses, ensuring that different healthcare needs are met. HCSC's plans work by collecting premiums from members, which then fund the healthcare services covered under these plans. What sets HCSC apart from other health insurance providers is its strong focus on health and wellness programs aimed at reducing overall healthcare costs and improving the health outcomes of its members. The goal of HCSC is to be a reliable partner in health, promoting quality care and supporting individuals in leading healthier lives.

Company Stage

N/A

Total Funding

$472.7M

Headquarters

Chicago, Illinois

Founded

1936

Simplify Jobs

Simplify's Take

What believers are saying

  • HCSC's acquisition of Cigna's Medicare businesses expands its reach in the growing Medicare market.
  • The new Houston office will create job opportunities and drive economic growth in Texas.
  • Rising telehealth adoption presents opportunities for HCSC to expand its telehealth services.

What critics are saying

  • Increased competition in the Medicare market could impact HCSC's market share.
  • Integrating Cigna's Medicare businesses may lead to operational inefficiencies.

What makes HCSC unique

  • HCSC offers comprehensive health insurance plans tailored to diverse client needs.
  • The company invests in health and wellness programs to improve member outcomes.
  • HCSC has nearly a century of experience in the health insurance industry.

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