Director, Provider Relations - The Health Plan

 
Position: Director, Provider Relations - The Health Plan

Job ID: 166948

Location: US-TX-Houston

Department: Provider Relations Admin

Talent Area: Administrative Support

Full/Part Time: Full time

Regular/Temporary: Regular

Shift: 8a - 5p Monday - Friday

About Texas Children's Hospital

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.

To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.

Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.


Summary:

We are searching for a Director of Provider Relations — someone who works well in a fast-paced setting. In this position, you will be responsible for maintaining a best-in-class provider network management organization that spans multiple service delivery areas and products. This includes all functions and systems supporting provider relations, provider communication, network capacity, appointment accessibility and provider satisfaction for the Health Plan. The director of Provider Relations plays an integral role in setting cross-functional alternative payment model strategies, supporting innovative service delivery methods including telehealth and ensuring accurately functioning provider processes across the provider lifecycle.

Think you’ve got what it takes?
 

Job Duties & Responsibilities
•    Responsible for coordinating and executing a network provider strategy and developing and leveraging operational relationships, quality controls and workflows to provide best-in-class provider service.
•    Develops strategy for alternative payment models (APMs) across provider specialties in order to achieve regulatory requirements.
•    Knowledgeable in regulatory requirements related to provider communications. Develops internal processes for provider communication requests, review and publication including tiered approach to provider outreach.
•    Directs activities related to developing and administering policy, short and long-range goals, strategic planning initiatives, internal and external reporting and regulatory communication.
•    Develop systems to ensure effective coordination between network providers, care management, quality, claims, customer service and network contracting 
•    Assist with the development and maintenance of a robust provider network that meets state-defined accessibility standards and incorporates continuous quality improvement and effective outreach programming
•    Establish readiness plans for product expansion, assimilation, and regulatory review
•    Mentor and develop staff toward expansion of professional roles to meet the continuous challenges and changes in managed care, contractual and legislative regulations, including promoting the ability to respond effectively to innovation and capacity management

Skills & Requirements

•    Bachelor’s degree in healthcare administration, business administration or a related healthcare or business field
•    A minimum of 7 years’ experience in healthcare management and managed care experience
•    2 years’ experience in leadership/management role
•    Master’s degree in Healthcare Administration, Business Administration or related healthcare or business field can substitute for 2 years of general experience (does not substitute for Leadership experience)
•    Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children’s, unless approved for a medical or religious exemption
 



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