Manager, Contracting - The Health Plan

 
Position: Manager, Contracting - The Health Plan

Job ID: 164038

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 a Contracting Manager — someone who works well in a fast-paced setting. In this position, you will manage and maintain procedures supporting the rules and regulations as set by all regulatory entities to ensure timely processing of contracting information meeting all regulatory requirements including timeframes, documentation, and communication with providers.

Think you’ve got what it takes?



Responsibilities :

Job Duties

  • Supervise staff responsible for the processing of the contracting information
  • Ensure all contract documentation is processed within state guidelines
  • Communicate with providers of needed or missing contract documentation to ensure timely processing
  • Work with internal departments to coordinate the completion of the contracting process and communicate with providers' updates and/or status of their application and contract
  • Maintain procedures to ensure that all providers are properly credentialed and contracted prior to being effective, and ensures providers are notified of their effective date
  • Represent Network Management at various meetings, both internal and external
  • Assure timely responses to interested providers including notification to providers of the receipt of an interest letter or form, requesting any additional information needed for review of the Letter of Interest Committee, processing all recruitment and denial decisions timely and documenting those decisions for quarterly submission to HHSC
  • Oversee timely submission of the HHSC report due quarterly
  • Assure compliance with all regulatory and accreditation rules and regulations as they relate to network accessibility, professional services, and coordinate responses to Texas Health and Human Services provider complaints with claims director, business systems assistant director and Provider Relations
  • Ensure all documentation is received for processing and shares outcome/results to the appropriate people
  • Create and maintain audit tools to monitor staff productivity, work quality and accuracy
  • Establishes reports to share with leadership the volume of the various tasks assigned to staff and make recommendations of process improvements and/or if additional resources are needed.
  • Create monthly, quarterly and annual goals for staff and monitor their progress


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 Required
  • 4 Years of Healthcare, or Contracts Expertise Required


Apply Now
Current Texas Children’s employees – Please click here to login.
Create Profile or Log In Search Careers