Senior Business Process Specialist - Managed Care

 
Position: Senior Business Process Specialist - Managed Care

Job ID: 154030

Location: US-TX-Bellaire

Department: BUSINESS OPERATIONS - ADMIN

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a-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 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 Business Process Specialist -- someone who works well in a fast-paced setting. In this position, you will develop and implement strategies to ensure optimal organizational operations that supports the development and maintenance of a network of hospitals, physicians and other healthcare providers. This role will support and develop programs aligned with our organization’s strategic goals through effective and timely assessment and equitable distribution of resources, assignments, education and implementation of processes and procedures that provide and maintain a cost-effective provider network. 

 

We are looking for a self starter with previous experenience working for a managed care organization and project management experience.

 

Think you’ve got what it takes?



Responsibilities :

  • Plan, develop, organize, direct and implement a coordinated approach to ensure regulatory adherence for provider network operations
  • Proactively identifies changes in NCQA, TDI, HHSC and contract requirements as for impacts to health plan providers
  • Provides network operations oversight and analysis of network services, trends, complaint findings, and growth strategies
  • Ensures compliance with complaints and issues tracking and monitoring for corporate and regulatory communications
  • Develops approaches, policies and programs for network operations and ongoing network development which are based on the organization’s goals and objectives
  • Supports the delivery of cost effective, community-based and culturally sensitive health care with specific emphasis on network operations that promote best member outcomes and provider satisfaction
  • Assesses resource utilization and cost management


Qualifications:

  • Bachelor’s degree in business, health care administration, public health, nursing, MIS or an IS related field required
  • Master degree in business, health care administration, public health, nursing, MIS or an IS related field preferred
  • 4 years’ managed care experience in a managed care organization required
  • 5 years’ master proficiency in SQL, MS access, and data analysis within an MCO preferred
  • A Master's degree in Business, Health Care Administration, Public Health, Nursing, MIS or an IS related field may substitute for 2 years of experience


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