Senior Managed Care Contracts Administrator

 
Position: Senior Managed Care Contracts Administrator

Job ID: 153349

Location: US-TX-Houston

Department: PAYER CONTRACTING & RELATIONS

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8am-5pm

About Texas Children's Hospital

Since 1954, Texas Children’s has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children’s hospital in Texas, and among the top in the nation by U.S.News & World Report as well as recognition from Houston Business Journal as one of this city’s Best Places to Work for ten consecutive years.   Texas Children’s comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Center for pediatric research; Texas Children’s Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children’s Hospital West Campus, a community hospital in suburban West Houston; and Texas Children’s Hospital The Woodlands, the first hospital devoted to children’s care for communities north of Houston. We have also created the nation’s first HMO for children, established the largest pediatric primary care network in the country and a global health program that is channeling care to children and women all over the world. Texas Children’s Hospital is also academically affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation.   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.   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 Senior Managed Care Contract Administrator — someone who works well in a fast-paced setting. In this position, you will responsible for the analysis, negotiation, and implementation of contracts, letters of agreement (LOA), and single case agreements with commercial and Texas managed Medicaid health plans on behalf of the organization. This role is also be responsible for developing and maintaining positive relationships with individuals at all levels of authority within each health plan. Lastly, this position may interact with attorneys, directors, managers, and peers daily, while managing and completing major departmental projects including recommending project plans & recommending resource allocations.

 

Think you’ve got what it takes?



Responsibilities :

  • Negotiate hospital and physician group contract language and rates using established parameters/guidelines
  • Evaluate hospital and physician group claims data to determine service lines which influence medical expenses
  • Develop and maintain strategic relationships with IDS personnel and health plans at all levels of authority
  • Assure compliance with regulatory requirements and product requirements related to provider contracting functions
  • Consult with management and integrated delivery system component leaders as needed to establish managed-care contracting strategy
  • Receive and review boilerplate contract documents from health plans and work with the Credentialing department to address any provider load issues
  • Communicate health plan trends/announcements to management and other internal parties as appropriate promptly


Qualifications:

  • High school diploma or GED
  • A minimum of 9 years’ experience in hospital managed-care, in a facility contracting, provider relations, or hospital business office role
  • A bachelor’s degree will substitute four (4) years of work experience and a master’s degree will substitute for two (2) years of work experience


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