Assistant Director, Network Development - Contracts Administration - The Health Plan **FULLY REMOTE**

 
Position: Assistant Director, Network Development - Contracts Administration - The Health Plan **FULLY REMOTE**

Job ID: 163222

Location: US-TX-Houston

Department: Contract Administration

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 an Assistant Director of Network Development -- someone who oversees the development and maintenance of the contracted network of hospitals, physicians and other healthcare providers who provide care to Texas Children's Health Plan. This position assists in the development of policies and procedures for provider contracting which meet regulatory and compliance standards and are consistent with the needs and standards of the health plan. The Assistant Director evaluates and negotiates contracts with our providers in compliance with health plan contract templates, reimbursement structure standards and other key process controls. Responsibilities also include establish and maintaining strong business relationships with hospitals, physicians and ancillary providers and ensure the network composition includes an appropriate distribution of provider specialties.

 

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Responsibilities :

Job Duties and Responsibilities:

  • Provides leadership in the development, direction, execution, and evaluation of effective provider contracting for hospitals, physicians and other healthcare providers meeting compliance and regulatory requirements. Streamlines and manages processes to ensure effective coordination between network providers, finance, legal, provider relations, care management, quality, claims, customer service and network contracting. Works to enhance provider network satisfaction as needed.
  • Evaluates and develops approaches, policies, and programs which are designed to meet goals and objectives and are based upon analysis of member and provider use patterns, including cultural needs and preferences.
  • Supports and drives execution for the contracting department’s key strategic initiatives including creating and monitoring implementation plans.
  • Mentors and develops TCHP staff toward expansion of professional roles in order 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.


Qualifications:

Skills and Qualifications:

  • 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.
  • Bachelor’s degree in business, health care, public health or related field required
  • 7 years managed care experience in a managed care organization required
  • 3 years leadership/management experience required
  • A master’s degree may substitute for two years of either/both experience requirements


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