Director, Provider Relations - The Health Plan

About Texas Children's Hospital

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.

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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