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
We are searching for a Manager of Contract Implementation – someone who works well in a fast-paced managed care setting. In this position, you’ll 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. You will formally responsible for making recommendations regarding policies associated with the job’s purpose and essential responsibilities. Lastly, you will make routine decisions include setting work priorities for staff, hiring of staff, and the assessment of regional needs and priorities to assist in maintaining network adequacy and meeting rules and regulations around the contracting process.
Think you’ve got what it takes?
- Supervises staff responsible for the processing of the contracting information including ensuring all contract documentation is processed within state guidelines, communicating with providers of needed or missing contract documentation to ensure timely processing, working with internal departments to coordinate the completion of the contracting process and communicating with providers’ updates and/or status of their application and contract
- Maintains procedures to ensure that all providers are properly credentialed and contracted prior to being effective, and ensures providers are notified of their effective date
- Responsible for the oversight of responding to provider requests to join the provider network timely and in a consistent manner
- Assures 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
- Oversees timely submission of the HHSC report due quarterly
- Ensures timely review and response to all calls, faxes and emails received to the Network Management email and phone queue
- Assures 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
- Ensures timely processing of provider additions, changes and terminations assigned to the Network Management Department and communicate status of those updates to internal departments and providers
- Creates and maintains audit tools to monitor staff productivity, work quality and accuracy
- Four years of health care, managed care, or contracts experience
- Ability to be an effective communicator to a broad spectrum of employees and providers. And continued currency in industry changes
- Knowledge of managed care industry, cultural competence, rules and regulations that affect a HMO in the state of Texas including clean claims laws, rules and regulations
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