Director, Provider Relations - Community Health Choice
Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:
• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.
Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
The Director, Provider Relations is responsible for the day-to-day supervision of the Provider Relations staff and day-to-day management and oversight of the operations of the Provider Relations Department, This position is responsible for but not limited to; (1) maintenance of Community's formal Provider Education Plan, including but not limited to, strategic annual revisions and execution of Provider Incentive Programs and improvement of the Provider Satisfaction Survey results, (2) timely and efficient general communication with participating providers, (3) timely and efficient resolution of general provider inquiries and/or complaints, (4) collaboration with staff from other health plan departments as it relates to maintenance of Community's provider networks from an Access/Availability and competitive standpoint, (5) identifying and implementing innovative means to improve provider engagement and overall performance, and (6) compliance with all local, state and federal laws and regulations, obligations set forth by HHSC and CMS, as well as any accreditation standards prescribed by NCQA and URAC.
- BA in Business/Marketing or related field. Four years equivalent work experience may substitute for degree requirement.
- Seven years of experience and training in Provider Relations, contracting, and/or physician practice management. Working knowledge of local provider community and various healthcare delivery systems preferred. Working knowledge of claims processing preferred.
- Five years of experience in a Provider management role, preferably in, Provider Relations, and/or Provider Contracting department.
- Exceptional verbal communication skills.
- Writing /Composing: Correspondence /Reports
- Analytical, Medical Terminology, Research, Statistical,
- MS Word, MS Excel
Please be advised: Effective Wednesday, September 1st, 2021, with the exception of those who receive an approved exemption, all new hires must provide proof of vaccination against COVID-19 or receive the first dose of a COVID-19 vaccine by the second Friday of employment.
Benefits and EEOC
Community employees’ benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and choices in meeting your specific needs.
Community is an Equal Opportunity Employer.