VP, Provider Network and Operations/ CHC
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.
The Vice President, Provider Network and Operations is responsible for the strategic direction and oversight for all non-clinical Provider-facing functions, to include Contracting, Provider Relations, Credentialing, Provider Data Integrity, Network Administration, Claims Audit and Claims. This VP, directs the strategic development and maintenance of Community's networks of Providers for all HHSC, Marketplace and other commercial programs and leads the development and maintenance of a robust Provider Engagement Program that rewards and incentivizes Providers to achieve Community's goals, including the movement of a greater percentage of Community's provider contracts to a value-based payment methodology. Leads the oversight and vendor management of material sub-contractors and third party administration parties and responsible for the Provider Education Program for all of Community's Provider Networks. Ensures accurate, timely and compliant claims payment processes, including communication with Providers regarding claims payments.
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.