Location:
Calmont Operations BuildingDepartment:
Network MgmtShift:
First Shift (United States of America)Standard Weekly Hours:
40Summary:
Plans, organizes, staffs, and coordinates all activities of the Health Plans Network Management Department. Works with Staff and Senior Management to develop and implement provider contracting strategies and provider service strategies to improve member access and enhance Provider satisfaction with the Health Plan. Primary Health Plan liaison for Claims, Member Services, Care Management, and other key departments within the Health Plan. Responsible for facilitating positive, professional relationships within the managed care organization, Providers, and the community. Responsible for the oversight and management of all physician, hospital and ancillary provider relationships.Additional Information:
Cook Children's Health Plan is looking for a Director, Network Management. As the Director, you will plan, organize, staff, and coordinate all activities of the Health Plan's Network Management Department. You will work with staff and senior management to develop and implement provider contracting strategies and provider service strategies to improve member access. and enhance provider satisfaction with the Health Plan. You, as the Director, will be the primary Health Plan liaison for Claims, Member Services, Care Management, and other key departments within the Health Plan.
The director is also responsible for facilitating positive, professional relationships within the managed care organization, providers, and the community. You will have oversight and management of all physician, hospital and ancillary provider relationships.
Qualifications:
Bachelors' degree required, MBA preferred
Advanced training in healthcare, business, or a related field required
Five to ten years operational experience in a health care organization preferably in the area of provider network management
Minimum of five years team management experience
Must demonstrate proven success in establishing and maintaining positive working relationships with health care providers and their staffs
Working knowledge of HMO business operations specifically the functions of utilization management, member services, claims, credentialing and benefit plan interpretation
Experience preparing and presenting information to individuals and groups
Must be attentive to detail, have excellent organizational, problem solving, verbal and written communication skills
Strong customer service orientation and skill set
Must be able to work independently and actively participate as an integrated team member
Analytical thought processes and strong organizational, conflict resolution, and facilitation skills
Team and collaboration oriented, performance driven
About Us:
Cook Children's Health Plan
Cook Children's Health Plan provides vital coverage to nearly 120,000 people in low-income families who qualify for government-sponsored programs in our six county service region. Cook Children's Health Plan provides health coverage for CHIP, CHIP Perinatal, STAR (Medicaid) and STAR Kids Members in the Tarrant county service area. The counties we serve includes Tarrant, Johnson, Denton, Parker, Hood and Wise.
Cook Children's is an EOE/AA, Minority/Female/Disability/Veteran employer.