Health Care Service Corporation

Strategy

• Ensure field contractors comply with contracting standards, regulatory requirements, governing standard templates, reimbursement standards, network and contract policy, and the non-standard deviation process
• Provide direct and ongoing guidance and support to field contractors on contracting standards, LOB regulations, and use of the Contract Management System (Contract Manager)
• Support field contractors on non-standard issues
• Work closely with Legal, Compliance, and Matrix Leadership on policy, language, and “ability to administer” issues
• Support reporting and compliance with the Governance non-standards review process
• Work within the Governance Department responsible for Network Standards, Systems, Contracting Governance, and Network Governance for Providers and Suppliers
• Support the broader NBS Organization and work within the larger NBS Governance Team
• Lead and formulate strategy
• Drive results across departments in a matrixed environment
• Work directly with corporate leadership
• Manage multiple complex priorities

Principal Divisional Strategy Consultant – Governance

Data Analyst

• Lead a team of analytics professionals supporting Strategic Sourcing, Contracting, and Vendor Management
• Develop actionable insights from spend, supplier, contract, market, and operational data
• Drive cost optimization, value creation, risk mitigation, operational insights, and supplier performance improvements
• Establish data ownership, governance standards, and accountability for procurement-related data assets
• Ensure data consistency, quality, accessibility, and compliance across the department
• Partner with Procurement, Finance, Operations, and business stakeholders
• Develop data-driven visualizations
• Deliver executive-level insights
• Advance analytics capabilities
• Enable informed decision-making that maximizes vendor return on investment

Senior Manager, Analytics Consulting – Sourcing & Vendor Strategy

Contract Specialist

• Draft account-specific documents, including contract templates
• Review non-standard document language requests
• Submit Department of Insurance regulatory filings
• Source and review contracts for audit, legal, and compliance requirements
• Ensure accuracy and consistency of contract documents
• Support day-to-day operations of the team
• Elevate concerns to management
• Act as a liaison between staff, management, and key stakeholders
• Draft and edit desk level procedures and workflow documents

Senior Contract Specialist

Representative

• Plan and direct provider recruitment and contracting activities
• Educate providers on plan benefits, policies, procedures, and reimbursement processes
• Provide ongoing provider service and support
• Resolve complex provider issues
• Serve as a liaison between providers and internal business partners
• Train new and existing network staff
• Conduct provider office visits in the Austin, Texas market
• Travel within assigned areas of responsibility, including overnight stays

Senior Provider Relations Representative

Consultant

• Support HCSC's quality imperatives, value-based care models, and provider relationships
• Collaboratively work with assigned medical practices or individual PCPs, the appropriate Medical Director and Clinic Directors, and medical and non-medical quality staff
• Improve key targeted HEDIS measures
• Participate in model and program development
• Conduct clinical readiness assessments
• Support entity- and network-management-led joint operating committees
• Obtain EMR access
• Implement provider-based member outreach initiatives and provider supplemental data submissions
• Retrieve key medical records throughout the year
• Provide ongoing and annual evaluation of the effectiveness of the overall quality improvement program for the assigned line of business
• Create and maintain strong working relationships with care coordination and care management teams at the value-based entity, local Network Management, and internal Clinical Operations teams
• Provide consultative support and ensure operational needs are being met
• Travel, including overnight stays

Clinical Practice Consultant

Analyst

• Participate actively in HCSC’s formal internship program
• Own components of project work and deliverables with guidance from an assigned mentor and manager
• Conduct research, analyze data and information, and develop recommendations informing real business decisions
• Collaborate with cross-functional business and technical teams
• Support departmental initiatives improving business outcomes and member and client experience
• Learn and apply organizational processes, programs, and technologies with increasing independence and ownership
• Develop and deliver a final internship presentation to department leadership covering the project, results, and recommendations
• Maintain complete confidentiality of company business and comply with HIPAA, Diversity Principles, Corporate Integrity, and applicable compliance policies

Technology Delivery Analyst Intern

Product Manager

• Lead the strategy, development, and ongoing management of Medicare Part D products
• Coordinate Prescription Drug Plan (PDP) and Medicare Advantage Prescription Drug (MAPD) offerings
• Own plan design, competitive intelligence, annual bid activities, and bid quality oversight
• Drive cross-functional execution to support product performance and growth
• Manage and develop a team
• Partner with sales, marketing, finance, operations, and clinical stakeholders
• Serve as a subject matter expert throughout the product lifecycle
• Evaluate market trends, customer needs, and product performance
• Inform strategic planning and support new product development
• Ensure effective management of a complex Medicare product portfolio

Senior Manager, Product Solutions – Medicare Part D

Manager

• Manage daily activities and implement strategies to improve provider HEDIS, STARS, risk adjustment, and financial performance
• Lead provider recruitment and contracting efforts for physicians, physician groups, and facilities, including large or complex health systems and value-based arrangements
• Develop and negotiate contracts
• Build and maintain strong provider relationships
• Ensure strategic coverage within the assigned territory
• Provide ongoing provider education and service
• Lead a team of Provider Performance Network Operations Consultants
• Manage, mentor, and train provider support resources
• Serve as a subject matter expert to improve efficiencies and results
• Engage physicians and influence behavior change
• Identify performance improvement opportunities and develop actionable plans
• Measure outcomes and adjust strategies to achieve client goals in a value-based care environment
• Work onsite at provider offices typically 3 days a week and from home 2 days a week
• Attend infrequent evening and weekend meetings

Manager, Network Management – Provider Performance

• Manage development and maintenance of harmonious working relationships with assigned providers
• Negotiate provider agreements
• Assign responsibilities to team members
• Lead staff through training, coaching, performance management, and other supervisory responsibilities
• Oversee performance and growth of an assigned provider network
• Partner with providers and internal stakeholders to drive quality, affordability, operational excellence, and member satisfaction
• Provide leadership for Provider Performance teams
• Oversee provider network financial performance and value-based initiatives
• Support Stars and Risk Adjustment goals
• Ensure compliance with CMS and company policies
• Collaborate across the organization to strengthen provider relationships, improve health outcomes, and support growth and profitability of the HealthSpring Medicare Advantage business
• Work onsite at provider offices typically 3 days a week and from home 2 days a week
• Attend infrequent evening and weekend meetings

Senior Manager, Provider Network Performance

Program Manager

• Lead Information Security's strategic vendor relationship management programs
• Lead merger and acquisition security integration programs
• Serve as liaison between Information Security, business leaders, Procurement, Legal, Enterprise Architecture, Corporate Development, and external partners
• Establish governance frameworks
• Drive strategic security partnerships with key suppliers
• Oversee security due diligence activities
• Lead post-acquisition security integration efforts
• Influence cross-functional stakeholders and provide risk and strategic recommendations

Principal Program Manager

• Support HEDIS, STARS, and financial provider performance and contracting activities
• Ensure strategic provider coverage within an assigned territory
• Negotiate contracts with 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
• Adapt strategies to achieve client goals
• Work onsite at provider offices up to 3 days weekly and from home typically 2 days weekly

Network Management Consultant – Provider Performance

• 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

Sales

• Lead Individual Medicare sales across an assigned territory through a team of Broker Sales Representatives
• Provide strategic leadership for broker distribution, market growth, operational execution, talent development, and broker engagement
• Ensure alignment with enterprise sales priorities
• Partner with Market Finance, Provider Performance & Engagement, Network Management, Contracting, Marketing, Sales Operations, Product, Compliance, and executive leadership
• Identify growth opportunities and remove enrollment barriers
• Strengthen broker relationships and execute local market growth strategies
• Achieve membership growth and execute market strategies
• Develop high-performing sales professionals
• Drive market performance and foster collaborative relationships with internal and external stakeholders
• Travel regularly throughout the assigned territory

Senior Manager, Medicare Regional Sales

Pharmacist

• Provide comprehensive pharmacy network oversight across all Medicare plans
• Manage day-to-day operations with external pharmacy benefit managers
• Monitor network pharmacies to ensure pricing setup accuracy and operational quality standards
• Drive PBM vendor performance and operational integrity
• Research claims and test benefit design implementations
• Oversee PBM mail order and customer service functions
• Ensure compliance with Medicare, Medicaid, and enterprise regulatory standards

Pharmacy Programs Manager

• Supervise and oversee day-to-day operations of the Pharmacy Operations unit
• Resolve pharmacy issues involving claims, coding, pricing, and related matters
• Manage data and reporting on pharmacy operations
• Ensure issues are resolved in a timely and accurate manner
• Work with internal departments and vendors to resolve issues

Principal Divisional Strategy Consultant – Governance

Senior Manager, Analytics Consulting – Sourcing & Vendor Strategy

Senior Contract Specialist

Senior Provider Relations Representative

Clinical Practice Consultant

Technology Delivery Analyst Intern

Senior Manager, Product Solutions – Medicare Part D

Manager, Network Management – Provider Performance

Senior Manager, Provider Network Performance

Principal Program Manager

Network Management Consultant – Provider Performance

Network Management Consultant – Provider Performance

Senior Manager, Medicare Regional Sales

Pharmacy Programs Manager

Sup Pharmacy Programs