Sr Provider Network Strategy Consultant - BCBS

Job ID: PT-1019701 Description:

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.

If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can email us here to request reasonable accommodations.

Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "my account" and click on "View your job submissions".

BASIC FUNCTION:

This position is responsible for Value Based Care and New Network strategy and development activities at an advanced consultative level to enhance market stance, competitive capabilities and profitability. Responsible for the identification, evaluation and development of Innovative Network / Care Management Solutions; direction and expansion of Value Based Care provider contracting (Patient Center Medical Home, ACO, Bundled Payment models); identification and evaluation of competitive Provider pricing models, high economic value and Performance Based Reimbursement programs; assessment of new Network opportunities and value propositions; and development, promotion and presentation of Network advantages/strengths.

JOB REQUIREMENTS:

  • Bachelor's Degree and 6 years Managed Care or Network Management experience at the Health Plan level or 10 years Managed Care or Network Management experience at the Health Plan level.
  • Experience in Provider contracting and negotiations.
  • Experience in financial analysis related to Provider Reimbursement, Payment Methodologies and Provider Performance measures.
  • Innovation and strategy skills
  • Consultative skills
  • Analytical skills and experience developing Analytical Presentation and Pricing Models.
  • Clear, concise and effective verbal and written communication skills including interpersonal and presentation skills
  • Strategic Thinking, critical thinking and problem solving skills
  • Business acumen and ability to build credibility with all levels of the organization
  • Financial acumen
  • Independence, resourcefulness and ability to meet deadlines
  • Knowledge of healthcare benefits, terminology and concepts.
  • Experience developing and presenting to executives or provider groups; strong delivery skills.
  • Knowledge of network management trends and innovations.
  • Ability to collaborate effectively with stakeholders and key internal partners.

PREFERRED JOB REQUIREMENTS:

  • Master's Degree
  • Experience in use of Membership data, Premium data and/or Claims data.
  • Knowledge of State and Federal laws and regulations.
  • Experience with Network Management Pricing modeling.
  • Experience in Innovation
  • LI CB CA

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


Meet Some of HCSC's Employees

Allison M.

Internal Auditor

Allison audits operational and financial data throughout the business, helping to expose and mitigate risks, ensure compliance, and add value to HCSC’s operations as a whole.

Rosa Y.

Claims Examiner

Rosa works to process claims that stop due to system edits—researching the edits, correcting the errors, and completing the claims to help members and providers get paid.


Back to top