Provider Relations Liaison - The Health Plan - Tyler, Texas Area

 
Position: Provider Relations Liaison - The Health Plan - Tyler, Texas Area

Job ID: 163130

Location: US-TX-Tyler

Department: NE MRSA

Talent Area: Professional - Non-Clinical

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.  At Texas Children’s Hospital, diversity, equity, and inclusion are at the core of our values and mission for all of the patients and families that we serve. We are committed to providing a diverse and inclusive work environment for all faculty, staff and learners throughout our organization. We believe that each member of our one amazing team provides enrichment that allows us to create a lasting legacy for future employees of this great organization.   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 Provider Relations Liaison - someone who works well in a fast-paced managed care setting. In this position, you’ll plan, direct and maintain strategies that assure harmonious relationships are established and maintained with physicians and other providers and efficient, effective care is delivered within a discreet assigned territory. Additionally, you’ll educate providers through in-service programs that review policies and procedures physicians are obligated to adhere to, discuss physician feedback as necessary and promote continuing education classes and other educational programs that support the goals and objectives of the health plan.

Think you’ve got what it takes?



Responsibilities :

Job Duties & Responsibilities

  • Develops and maintains strong business relationships with participating providers
  • Responsible for development of a regional territory inclusive of provider selection and satisfaction as well as member growth and medical loss ratio
  • Resolves managed-care issues and/or problems related to claims, medical management, or member services issues
  • Identifies educational needs within the provider network and initiates educational efforts as needed or upon provider’s request
  • Develops and follows territory strategic plan aligned to our organizational mission and vision
  • Conducts territory assessment and develops strategic plan for service area based including interventions to meet growth projections of membership and influence medical loss ratio
  • Assures that monthly and quarterly mailings to providers are completed according to departmental policies and procedures
  • Assures that new providers receive a provider handbook within five (5) days of being added to plans
  • Creates Community and Provider Satisfaction
  • Represents Provider Relations at various meetings, both internal and external
  • Creates community outreach opportunities for marketing and educational purposes within territory
  • Ensures appropriate and thorough resolution of provider issues.
  • Delivers exceptional service to participating providers in assigned geographic region
  • Supports Regulatory and Operational Compliance
  • Submits provider visits reports in accordance with departmental policies and procedures meeting weekly with manager
  • Completes assigned projects including provider accessibility survey, after hours surveys, satisfaction surveys, newsletters, and updates to provider handbooks in a timely manner
  • Ensure timely completion of all team projects, assignments, and job duties Develop project plans for team projects and assignments and serves as Team Leader for various special projects as assigned by applicable Manager


Qualifications:

 

Qualifications & Requirements

  • High School Diploma/GED or Bachelor’s degree preferred (In Health Care, Business or related field)
  • A minimum of three (3) years of health care or managed care 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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