Job Description

Community Health Choice, Inc. (Community) is a non-profit Health Maintenance Organization (HMO) licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 70 hospitals, Community serves over 260,000 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.

Skills / Requirements

The Senior Regional Manager, Provider Relations is responsible for the day-to-day supervision and management of the Provider Relations staff, including, but not limited to; (1) maintenance of, and annual improvement in, Community’s formal Provider Education Plan, (2) timely and efficient communication with participating providers, (3) timely and efficient resolution of provider inquiries and/or complaints, (4) collaboration with staff from Contracting and Credentialing and Data Integrity teams as it relates to maintenance of Community’s provider network(s) 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 TXHHSC and CMS, as well as any accreditation standards prescribed by NCQA and URAC.

QUALIFICATIONS:

  • BA/BS required. Four years’ equivalent work experience may substitute for degree requirement.
  • Six years in the following areas: managed care with at least three years experience in Provider Relations/contracting with physicians, ancillaries, hospitals.
  • Two years experience in a management role.
  • Experience in STAR+PLUS a plus.

.Other Skills:

  • Must have medical contract negotiations experience, preferably in Houston market.
  • Writing /Composing, Correspondence/Reports
  • Must have car and valid Texas Driver's license.
  • Analytical, Medical Terms, Statistical, MS Word, MS Excel

 

Application Instructions

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