Assistant Director, Network Development - The Health Plan

About Texas Children's Hospital

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.
 
Think you’ve got what it takes?
 

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.
•    High School Diploma
•    7 years managed care experience in a managed care organization required
•    1 years leadership/management experience required
•    A master’s degree may substitute for two years of either/both experience requirements

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.
•    Works in concert with other TCHP leadership to provide direction and planning within the TCHP culture.
•    Monitors progress in operational units identifying areas for improvement initiatives.