Director, Provider Contracting
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.
- Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.
- 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 Director of Provider Contracting provides strategic leadership in the development, direction, execution, and evaluation of an effective contracting program. The Director is responsible for assuring the program supports the delivery of quality providers appropriately and effectively, and that meets all contractual and regulatory requirements. This position develops and maintains a robust provider network that meets state-defined accessibility standards and incorporates continuous quality improvement and effective outreach programming. In addition, the Director develops systems to ensure effective coordination between network providers and contracting and ensures the analysis of utilization and cost data is translated to program implementation. Assures that network and contracting function are aligned with organizational strategic objectives and financial targets.
- Education/Specialized Training/Licensure:
- BA/BS; 4 years equivalent work experience may substitute for degree requirement.
- Work Experience:
- 7 years in healthcare, with at least 5 years experience in Providers/Managed Care Contracting. Health Plan experience preferred. Must have medical contract negotiations experience, preferably in Houston market.
- Management Experience:
- 4 years of direct supervision experience required
- Software Operated: Microsoft Office (Word, Excel, Outlook)
- Must have car and valid Texas Drivers license
- Contracting experience with both hospital and physician practice (group practice and solo practitioner) required.
- Skilled at developing and implementing strategic objectives for the contracting function.
- Experience with implementing provider incentive programs and pay-for-quality programs.
- Experience with claims payment and CRM systems required. QNXT and Salesforce preferred.
- Demonstrated ability to manage and develop staff in medical contract negotiation.
- Communication Skills:
- Above Average Verbal (Heavy Public Contact)
- Writing /Composing: Correspondence / Reports
- Other Skills: Analytical, Medical Terminology, Statistical, MS Word, MS Excel
- Advanced Education: Bachelors Degree
- Work Schedule: Flexible
RESPONSIBLE TO: Vice President
EMPLOYEE SUPERVISED: Professionals and Clerical Staff
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Job Status: Full Time
Job Reference #: 166897