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Network Management Consultant – Provider Performance
Health Care Service Corporation. Support HEDIS, STARS, and financial provider performance and contracting activities .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in provider contract negotiation and management, with a strong focus on HEDIS, STARS, and value-based care performance. Proficient in leveraging analytics to drive outcomes and improve provider relationships within a managed care environment.
Highest-signal resume keywords
Provider Contract NegotiationHEDIS and STARS ExperienceAnalytical SkillsMicrosoft Excel ProficiencyHealth Insurance Knowledge
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Provider ContractingHEDISSTARSRisk AdjustmentValue-Based CareFinancial AnalysisProject ManagementData AnalyticsEMR ExperiencePopulation Health Tools
Soft Skills
Verbal CommunicationWritten CommunicationOrganizational SkillsPlanning SkillsRelationship Management
Tools & Technologies
Microsoft OfficeExcelPivot TablesVLOOKUP
Industry Keywords
Managed Care OperationsProtected Health Information (PHI)HIPAA ComplianceProvider OutreachCustomer Messaging
About the role
Key responsibilities & impact- Support HEDIS, STARS, and financial provider performance and contracting activities
- Ensure strategic provider coverage within an assigned territory
- Negotiate contracts for physicians, physician groups, and small to mid-size hospitals
- Support complex hospital and physician contracting initiatives
- Develop and maintain strong provider relationships
- Deliver ongoing provider education and service
- Drive HEDIS, STARS, risk adjustment, and value-based care performance
- Engage providers and identify performance improvement opportunities
- Develop and execute action plans
- Leverage analytics to influence outcomes and adapt strategies to achieve client goals
- Work onsite at provider offices up to 3 days a week and from home typically 2 days a week
- Attend infrequent evening and weekend meetings
Requirements
What you’ll need- Bachelor Degree and at least one year experience developing and negotiating provider contracts OR 5 years managed care operations experience handling independent work with at least one year experience developing and negotiating provider contracts
- Meet deadlines and work well under pressure
- Verbal and written communication skills
- Organizational and planning skills
- PC proficiency including Microsoft Office
- Analytical skills
- Ability and willingness to travel within assigned territory, including overnight stays
- Sponsorship is not available
- Preferred: Bachelor Degree in Business
- Preferred: Previous HEDIS and/or CMS STARs experience
- Preferred: Solid understanding of health insurance, customer messaging/design, and project management
- Preferred: Expert-level Excel knowledge, including pivot tables and VLOOKUP
- Preferred: Experience in financial/trend analysis
- Preferred: Ability to foster and manage working relationships within a matrix environment
- Preferred: Experience with EMRs and population health tools
- Preferred: Provider outreach experience facilitating access and retrieval of medical records and chart notes
- Preferred: Compliant handling of Protected Health Information (PHI) in accordance with HIPAA requirements
Benefits
Comp & perks- 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
- Annual incentive bonus plan
- Professional development and curated development plans
- Other incentives