Director Network Management

 
Position: Director Network Management

Job ID: 158976

Location: US-TX-Houston

Department: Contract Administration

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8am-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 Director of Network Management -- someone who works well in a fast-paced setting. In this position, you will direct and oversee the Contracting Department for the development and maintenance of the contracted provider network of hospitals, physicians and other healthcare providers who provide care. This position directs the analysis and research of managed care trends and benchmarks needed for contract negotiations and for maintaining a cost-effective provider network. This position also provides direction in meeting operational and fiscal objectives through effective contracting for health services including facility, ancillary and professional services. In this role, the individual will direct the process of provider selection, contract initiation, negotiation, review and approval processes for all provider contracts. This position will have joint responsibility with the leaders in the configuration department to oversee how contractual fee schedules are implemented in the claims processing system to ensure accurate provider payment.

 

Think you’ve got what it takes?



Responsibilities :

  • Develops a strategic plan, budget and direction for network management department to ensure the organization meets organization goals, contractual requirements, compliance with HHSC and legislative regulations
  • Develops systems to ensure effective coordination between network providers, care management, quality, claims, customer service, network contracting and credentialing
  • Conducts ongoing evaluation of contracting rates and effectiveness of contract structures
  • Develops and implements strategy for contracting and reimbursement to achieve financial and strategic goals
  • Responsible for the development and maintenance of a robust provider network that meets state defined network adequacy, accessibility standards and incorporates continuous quality improvement and effective outreach programming
  • Manages the provider on-boarding process which includes, contracting, credentialing, system configuration and provider education resulting in a streamlined process for providers in a timeframe that meets or exceeds state requirements
  • Mentors and develops staff toward expansion of professional roles in order 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


Qualifications:

  • Being fully vaccinated against COVID-19 is required for all employees unless approved for a medical or religious exemption
  • Bachelor’s degree in Business, Healthcare, Public Health or related field required
  • 10 years managed care experience in a managed care organization required
  • 5 years leadership/management experience required
  • A master’s degree may substitute for 2 years of either/both experience requirements
  • JD is preferred


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