Assistant Director Health Plan Network Management

 
Position: Assistant Director Health Plan Network Management

Job ID: 148665

Location: US-TX-Bellaire

Department: Contract Administration

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8am-5pm

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 13,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.  

Summary:

We are searching for an Assistant Director of Network Management – someone who works well in a fast-paced setting. In this position, you’ll oversee the provider relations and satisfaction functions for the health plan and provider services by establishing and maintaining the necessary framework. You will also oversee the processes required to coordinate communication and programs to address the clinical and network needs of the health plan members and support members through the delivery system.

 

Think you’ve got what it takes?



Responsibilities :

  • Provide leadership in the development, direction, execution, and evaluation of an effective provider relations program that supports the delivery of quality healthcare most appropriately and effectively
  • Manage internal and external relationships and consultations
  • Streamline and manage processes to ensure effective coordination between network providers, care management, quality, claims, customer service, and network contracting
  • Ensure analysis of utilization and cost data is translated to program implementation and support, maximizing health status of members and financial outcomes for the client
  • 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
  • Plan, direct, staff, organize, and evaluate service models
  • Evaluate and develop approaches, policies, and programs which are designed to meet goals and objectives based upon analysis of member and provider use patterns
  • Implement readiness plans for product expansion, assimilation, and regulatory review
  • Develop best practice models which are cost effective and provide quality service to members
  • Mentor and develop staff toward expansion of professional roles to meet the continuous challenges and changes in managed care, contractual regulations, and legislative regulations, including promoting the ability to respond effectively to innovation and capacity management
  • Perform special projects and other duties as assigned


Qualifications:

  • Bachelor’s degree in business, healthcare, public health or related field required
  • Five years of managed care experience required
  • Three years of leadership or management experience required
  • Master’s degree may substitute for two years of experience requirements
  • Knowledge of concepts and techniques central to managed care, care management, community health, and provider relations
  • Knowledge of Medicaid and CHIP products
  • Knowledge of applicable state and federal laws and regulations related to managed care practice
  • Strong provider contract negotiation experience preferred


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