Manager, Provider Relations - The Health Plan

 
Position: Manager, Provider Relations - The Health Plan

Job ID: 154434

Location: US-TX-Bellaire

Department: PROVIDER RELATIONS OPERATIONS

Talent Area: Professional - Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p Monday - Friday

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 Manager of Provider Relations— someone who works well in a fast-paced setting. In this position, you will plan, direct, and maintain strategies that assure harmonious relationships are established and maintained with physicians and other providers. You will verify that efficient and effective care is being delivered to members and educate providers through in-service programs that review policies and procedures they're obligated to adhere to. Lastly, you will discuss physician feedback and promote continuing education classes and programs that support the goals and objectives of the health plan.

 

Think you’ve got what it takes?



Responsibilities :

 Job Duties & Responsibilities

  • Supervise staff responsible for the development of a regional territory inclusive of the provider’s selection and satisfaction as well as member growth and medical loss ratio
  • Conduct territory assessments in collaboration with staff, and develop a strategic plan for the service area including interventions to meet growth projections and influence medical loss ratios
  • Represent Provider Relations at various meetings, both internal and external which include IDS, stakeholder meetings, HHSC and TDI
  • Assure compliance with TDI rules and regulations as they relate to network accessibility and provider credentials
  • Investigate complaints, document findings, and make recommendations that adjudicate complaints to ensure that the health plan is in compliance with TDI, HHSC, and any other regulatory agencies as appropriate
  • Serve as team leader for various special projects, as assigned by the director, and related to strategic initiatives in regional territories


Qualifications:

Skills & Requirements

  • High school diploma or equivalent
  • Driver’s license from any state and
  • Current automobile insurance
  • Minimum of 8 years’ experience in healthcare or managed care
  • A bachelor’s degree may be substituted for four (4) years of experience, and an associate degree may be substituted for two (2) years of experience


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