Assistant Director, Provider Relations & Alternative Payment Models - The Health Plan

 
Position: Assistant Director, Provider Relations & Alternative Payment Models - The Health Plan

Job ID: 157449

Location: US-TX-Bellaire

Department: PROVIDER RELATIONS RESPONSE

Talent Area: Professional - Non-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 an Assistant Director of Provider Relations & Alternative Payment Models -- someone who works well in a fast-paced setting. In this position, you will ensure provider relations staff maintain deep understanding of provider programs such as contracted alternative payment models, provider incentive programs and HEDIS measures. This role ensures staff consistently deploys provider education on these topics and resolve provider issues timely. You will also support and develop programs aligned with strategic goals through effective and timely assessment and equitable distribution of resources and assignments, education and implementation of processes and procedures that provide and maintain a cost-effective provider network.

 

Think you’ve got what it takes?



Responsibilities :

 Job Duties & Responsibilities

  • Provides strategic market intelligence on providers, provider data and provider practices for Alternative Payment Models
  • Partners with the Manager of Value Based Contracting, Director of Quality and other internal leaders to re-evaluate programs and set strategic direction for APMs
  • Oversees manager of provider relations focused on provider data and provider inquiry investigation and response
  • Ensures staff maintain deep understanding of provider programs such as contracted alternative payment models, provider incentive programs and HEDIS measures
  • Develops, establishes and monitors cross-departmental processes impacting provider data integrity
  • countable for regulatory and operational reporting for provider terminations, network capacity, and other mission critical components to provider network management


Qualifications:

Skills & Requirements

  • Bachelor’s degree in Business, Health Care Administration, Public Health, Nursing or related field required
  • Master’s degree preferred
  • 5 years managed care, health care, or other related experience required
  • 2 years supervisory experience required


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