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
Procurement & Sourcing
Supply Chain Management
Operations & Logistics
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.
  • Plan, organize and coordinate the implementation of programs and activities designed to sustain and improve our working relationship with facilities/providers and to enhance HCSC’s image in the community.
  • 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.
  • Maintain direct strong working relationships with key providers, groups and community leaders.
  • Develop plans and recommend the solutions for dealing with issues with significant impact on the business to Senior Leadership.
  • Ensure communication to Sales and Actuarial of the impact of the changes in the network or the impact of projected fee schedules.
  • Work closely with Sales and the Data Analysis and Reporting team to assess the competitive position of the networks.
  • Analyze provider satisfaction survey results and formulate resolutions for problem trends which will aid in the maintenance of existing groups and the acquisition of new groups.
  • Maintain and further develop cooperative working relationship with other HCSC areas such as SSD, ITG, Credentialing and EHCM.
  • Promotes and facilitates expanding the use of existing technology to enhance the efficiency and effectiveness of business conducted between BCBS - Plan Division and facilities/providers.
  • Responsible for leadership of the facility and provider network groups.
  • People management responsibilities include but are not limited to performance management, pay administration, professional development, diversity, change management, and development and maintenance of budget.
  • Develop and monitor an effective communication/training program to keep contracting representatives apprised of new/additional servicing responsibilities.
  • Oversee provider/facility education and servicing including orientations, service calls and the production of education materials, and training of internal staff and other internal departments.
  • 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 generates revenue through premiums paid by its members and focuses on delivering quality care while also investing in health and wellness programs. These programs aim to lower overall healthcare costs and enhance the health outcomes of its members. With nearly 100 years of experience in the industry, HCSC stands out from its competitors by emphasizing compassion and a commitment to improving the health of the communities it serves.

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 capabilities in the Medicare market.
  • The new Houston office will create job opportunities and drive economic growth in Texas.
  • HCSC's enhanced cancer care offerings improve support for self-funded employers.

What critics are saying

  • Integrating Cigna's Medicare businesses may lead to operational inefficiencies for HCSC.
  • Economic downturns could impact the affordability of health insurance premiums, affecting revenue.
  • Rising healthcare costs may force HCSC to increase premiums, risking customer attrition.

What makes HCSC unique

  • HCSC's nearly century-long experience establishes it as a trusted health insurance provider.
  • The company focuses on innovation and compassion in delivering quality healthcare services.
  • HCSC invests in wellness programs to reduce costs and improve member outcomes.

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