Senior Manager, Contracting - 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.
• 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
JOB SUMMARY: The Senior Manager of Contracting will provide support to the Director of Contracting by assuring that Community achieves and maintains regulatory and accreditation compliance, as well as competitiveness, of its Provider networks for all lines of business (Medicaid/STAR, CHIP/CHIP Perinatal, Health Insurance Marketplace and others as determined by Community). This position is also responsible for contracting/re-contracting efforts or special projects, including but not limited to single case agreements, amendments, and service or product/program expansion. Manages and coordinates with all Community departments to ensure adequate set up and comprehensive interpretation of new contract fees and requirements. Assists with provider profiling, working closely with Finance, Analytics, Provider Relations, Member Services, Claims, and Medical Affairs to provide reports, assist with analysis and recommend actions. Requests, reviews, and analyzes quantitative analysis of various types of data including provider contracts, fee schedules, utilization and claims data needed for assessing, planning, budgeting, cost control and contract administration and makes recommendations for contracting rates and policies. Manages and helps mentor the staff that negotiate/maintain physician, hospital, ancillary and integrated health system contracts.
1. Education/Specialized Training/Licensure:
- BA/BS Preferred.
- 4 years equivalent work experience may substitute for degree requirement.
2. Work Experience (Years and Area):
- 5+ years in the following areas: managed care with at least 3 years experience in contracting with physicians, ancillaries, hospitals.
- Experience in value based contracting a plus.
3. Management Experience (Years and Area):
- Minimum 3+ years
4. Equipment Operated: Computer, fax, scanners, MS Office, company-specific systems
Above Average Verbal (Heavy Public Contact)
Writing /Composing, Correspondence Reports
Analytical , Medical Terms, Statistical, P.C. , MS Word, MS Excel
Advanced Education: Bachelor's Degree Major: BA/BS Preferred
Work Schedule: Flexible
Other Requirements: Must have car and valid Texas Drivers license.Must have medical contract negotations experience, preferably in Houston market.