Director, Provider Relations

2 weeks ago

Bellaire, United States Texas Children's Hospital Full time

Job Summary

We are searching for a Director of Provider Relations - someone who works well in a fast-paced setting. In this position, you will be responsible for maintaining a best-in-class provider network management organization that spans multiple service delivery areas and products. This includes all functions and systems supporting provider relations, provider communication, network capacity, appointment accessibility and provider satisfaction for the Health Plan. The director of Provider Relations plays an integral role in setting cross-functional alternative payment model strategies, supporting innovative service delivery methods including telehealth and ensuring accurately functioning provider processes across the provider lifecycle.

Think you've got what it takes?

Responsibilities

Job Duties & ResponsibilitiesHOU123

* Responsible for coordinating and executing a network provider strategy and developing and leveraging operational relationships, quality controls and workflows to provide best-in-class provider service.
* Develops strategy for alternative payment models (APMs) across provider specialties in order to achieve regulatory requirements.
* Knowledgeable in regulatory requirements related to provider communications. Develops internal processes for provider communication requests, review and publication including tiered approach to provider outreach.
* Directs activities related to developing and administering policy, short and long-range goals, strategic planning initiatives, internal and external reporting and regulatory communication.
* Develop systems to ensure effective coordination between network providers, care management, quality, claims, customer service and network contracting
* 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
* 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

Qualifications

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)
* Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children's, unless approved for a medical or religious exemption

Company Profile

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. At Texas Children's Hospital, diversity, equity, and inclusion are at the core of our values and mission for all of the patients and families that we serve. We are committed to providing a diverse and inclusive work environment for all faculty, staff and learners throughout our organization. We believe that each member of our one amazing team provides enrichment that allows us to create a lasting legacy for future employees of this great organization.

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.

  • Assistant Director of Public Works

    1 week ago

    Bellaire, United States City of Bellaire Texas Full time

    Assists the Director of Public Works in the managerial activities related to the operations of the Utility Services Division which includes storm drainage, water distribution, wastewater collection, wastewater and water treatment, automated metering Director, Public Works, Utilities, Operations, Assistant, Equipment Repair

  • Director of Parks, Recreation

    1 month ago

    Bellaire, United States City of Bellaire Full time

    Are you ready to make a difference in the Bellaire community? We're on the hunt for a dynamic and forward-thinking Director of Parks, Recreation, and Facilities to lead our team towards a brighter future. As the visionary leader in our organization, you'll spearhead initiatives to enhance the well-being of our community through recreation, community...

  • Assistant Director, Network Development

    2 weeks ago

    Bellaire, United States Texas Children's Hospital Full time

    Job Summary We are searching for an Assistant Director of Network Development -- someone who oversees the development and maintenance of the contracted network of hospitals, physicians and other healthcare providers who provide care to Texas Children's Health Plan. This position assists in the development of policies and procedures for provider contracting...

  • Location Director

    4 weeks ago

    Bellaire, United States The Enrichery Full time

    **About Us**: The Enrichery is a rapidly growing education company with a passion for student and family success. With four offices across Houston and plans for expansive growth, we provide Academic Coaching, Test Preparation, and College Admissions services to students of all ages. Our team thrives on strategy, innovation, and fostering a positive culture...

  • Clinical Research Site Manager/Director

    2 weeks ago

    Bellaire, United States EVOLUTION RESEARCH GROUP Full time

    Job DetailsJob LocationLOC009 HDR First Surgical Hospital - Bellaire, TXSite Manager/DirectorTitle: Site Manager Location: Bellaire, TXAbout us:ERG is a leading U.S. based, privately held, independent clinical research site company, and provider of clinical development services with expertise in early and late-stage neuroscience drug development. With 20...

  • Utilization Management Clinical Registered Nurse

    1 month ago

    Bellaire, United States Texas Children's Hospital Full time

    Utilization Management Clinical Registered Nurse - The Health Plan - RemoteJob Summary We are searching for a Utilization Management Clinical RN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization. This role...

  • Utilization Management Clinical Registered Nurse

    3 weeks ago

    Bellaire, United States Texas Children's Hospital Full time

    Utilization Management Clinical Registered Nurse (RN)Job Summary We are searching for a Utilization Management Clinical RN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization. This role performs telephonic...

  • Utilization Management Clinical Registered Nurse

    3 weeks ago

    Bellaire, United States Texas Children's Hospital Full time

    Utilization Management Clinical Registered Nurse (RN) - The Health PlanJob Summary We are searching for a Utilization Management Clinical RN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization. This role...

  • Driver - CDL

    2 weeks ago

    Bellaire, United States Five Star Senior Living Full time

    Key Responsibilities The Opportunity We are actively looking to add a Driver to our team. The primary objective for the Driver is providing safe, courteous, and on schedule transportation to our residents and their families. The Driver represents the organization by being visible throughout the community. Residents are to be treated with respect, courtesy,...

  • Project Coordinator

    4 weeks ago

    Bellaire, United States The Edge Group Full time

    Project CoordinatorBellaire, TXOur client, a fast-growing company in Bellaire, TX is hiring for a Project Coordinator. The company designs, fabricates, installs and services critical infrastructure protection devices into a broad and growing geography. Position SummaryReports to the Director of Operations. This is an ideal position for an individual who...

  • Marketer

    4 days ago

    Bellaire, United States Frontline Source Group Full time

    Our client in Bellaire, TX has an immediate need for a Marketer on a Direct Hire basis. Company Profile: Healthcare Industry Locally owned and operated Marketer Role: The Marketer will foster relationships with potential partners and referral sources, such as social workers, case managers, discharge planners, concierge doctors, and specialists, while...

  • Marketer

    1 day ago

    Bellaire, United States Frontline Source Group Full time

    Our client in Bellaire, TX has an immediate need for a Marketer on a Direct Hire basis.Company Profile:Healthcare Industry Locally owned and operatedMarketer Role:The Marketer will foster relationships with potential partners and referral sources, such as social workers, case managers, discharge planners, concierge doctors, and specialists, while actively...

  • Marketer

    6 days ago

    Bellaire, United States Frontline Source Group Full time

    Our client in Bellaire, TX has an immediate need for a Marketer on a Direct Hire basis.Company Profile:Healthcare Industry Locally owned and operatedMarketer Role:The Marketer will foster relationships with potential partners and referral sources, such as social workers, case managers, discharge planners, concierge doctors, and specialists, while actively...

  • Marketer

    6 days ago

    Bellaire, United States Frontline Source Group Full time

    Our client in Bellaire, TX has an immediate need for a Marketer on a Direct Hire basis.Company Profile:Healthcare Industry Locally owned and operatedMarketer Role:The Marketer will foster relationships with potential partners and referral sources, such as social workers, case managers, discharge planners, concierge doctors, and specialists, while actively...

  • Revenue Integrity Analyst

    6 days ago

    Bellaire, United States Texas Children's Hospital Full time

    Job Description We are searching for a Revenue Integrity Analyst - someone who works well in a fast-paced setting. In this position, you will lead, manage, and/or participate in all Revenue Integrity related projects as assigned by the Director. This role is also responsible for leading and/or supervising initiatives to improve or optimize efficiency while...

  • COVID-19 Field Medical Staff

    3 weeks ago

    Bellaire, TX, United States Texas Children's Hospital Full time

    Utilization Management Clinical Registered Nurse (RN) We are searching for a Utilization Management Clinical RN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization. This process includes clinical judgement,...

  • COVID-19 Field Medical Staff

    1 month ago

    Bellaire, TX, United States Texas Children's Hospital Full time

    Utilization Management Clinical Registered Nurse (RN) - The Health Plan We are searching for a Utilization Management Clinical RN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization. This process includes...

  • Vehicle Driver

    5 days ago

    Bellaire, United States LifeWise Academy Programs Full time

    Job DescriptionJob DescriptionOverview As a LifeWise vehicle driver in the LifeWise Bellaire Local program, you will provide safe and reliable transportation for public school students to and from the LifeWise site. Our ideal candidate is responsible and punctual and has a clean driving record.Job Responsibilities OverviewTransport children and LifeWise...

  • Utilization Management Clinical Licensed Vocational Nurse

    2 weeks ago

    Bellaire, United States Texas Children's Hospital Full time

    Job Summary We are searching for a Utilization Management Clinical LVN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and outpatient procedures and services requiring authorization. This process includes clinical judgment, utilization management application, verification...

  • Conference Services Coordinator

    3 weeks ago

    Bellaire, United States Shanty Creek Full time

    Job DescriptionJob DescriptionPosition Summary:Responsible for contacting all assigned groups booked by Sales Managers, to arrange and organize all aspects of a group's stay. Book and coordinate all function space for day functions (groups with no lodging rooms required). Coordinate with all other department to provide maximum service for all...