Director Medicare Network Programs
At HCSC, building a talent engine for the future is a key priority because we recognize that as our business evolves to reflect the changing world, we must adapt our workforce to meet this challenge. Additionally, with "excellence" one of our core values, we are focused on improving our success measures and delivering the best possible customer experience.
This position is responsible for managing a team responsible for provider recruitment, credentialing, education and servicing activities for public and custom networks. Public and custom networks include but are not limited to Tricare, Medicaid, CHIP and Medicare Advantage Dual programs. Responsible for building networks, negotiating agreements, monitoring reimbursement arrangements; and analyzing the networks regularly for provider accessibility and availability and network adequacy requirements per Centers for Medicaid and Medicare Services (CMS), Texas Health Human Service Commission (HHSC), Texas Medicaid & Healthcare Partnership (TMHP) other regulatory entities. This position will also report network development plans, budget resources, project status and deficiencies to internal and external executives and stakeholders. This position will work with Sales/Marketing, government programs, and subcontractors in accessing the competitive position of the networks as related to the market; and performing major new contracting activities for public and custom network programs.
Required Job Qualifications:
• Bachelor Degree with 5 years health care insurance administration, provider contracting including knowledge of value based agreements and managed care experience
• Informant of laws, regulations which affect our industries, including directives for how best to manage updates
• Work experience must include at least5 years public/government programs experience such as Medicaid/Chip and Medicare Advantage.
• 5 years management experience at a manager or director level including assisting in or responsible for development of strategies and initiatives.
• Experience and knowledge of CMS, state Department of Insurance, and HHS requirements and regulations.
• Analytical, planning, negotiating and contracting skills.
• Ability to travel, including overnight stays.
• Clear and concise verbal and written communication skills including interpersonal skills to represent company to external entities, resolve issues, and prepare executive and employee presentations.
• Experience with interacting with all levels of corporate personnel and providers.
• Relationship building acumen to develop relationships with providers.
• Leadership skills, team player, and relationship building acumen.
• Experience working in a fast-paced environment and meeting deadlines.
• Accuracy and sound judgment regarding financial matters such as contract performance and impact.
Preferred Job Qualifications:
• Preferred MBA or Masters in Health Administration
• Experience in public program RFP processes
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Requirements: Expertise Network Management / Provider Relations Job Type Full-Time Regular Location TX - Richardson
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