Director, Provider Relations - The Health Plan

Position: Director, Provider Relations - The Health Plan

Job ID: 154574

Location: US-TX-Bellaire


Talent Area: Administrative Support

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5pm 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 for career opportunities. You can also learn more about our amazing culture at   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.


We are searching for a Director of Provider Relations — someone who works well in a fast-paced setting. In this position, you will oversee provider relations and provider satisfaction functions for the Health Plan. These will include provider services by establishing and maintaining the necessary framework and the required processes to coordinate communication and programs to address the clinical and network needs.


Think you’ve got what it takes?

Responsibilities :

Job Duties & 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, and that meet the all contractual and regulatory requirements
  • Develop systems to ensure effective coordination between network providers, care management, quality, claims, customer service and network contracting
  • Ensure the analysis of utilization and cost data is translated to program implementation and support maximizing the health status of members and financial outcomes
  • 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
  • Establish readiness plans for product expansion, assimilation, and regulatory review
  • Mentor and develop staff toward expansion of professional roles to meet the continuous challenges and changes in managed care, contractual and legislative regulations, including promoting the ability to respond effectively to innovation and capacity management


Skills & Requirements


  • Bachelor’s degree in healthcare administration, business administration or a related healthcare or business field
  • A minimum of 7 years’ experience in healthcare management and managed care experience
  • 2 years’ experience in leadership/management role
  • Master’s degree in Healthcare Administration, Business Administration or related healthcare or business field can substitute for 2 years of general experience (does not substitute for Leadership experience)


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