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Director, Provider Relations and Network Management

Company: Memorial Hermann
Location: Houston
Posted on: August 21, 2019

Job Description:

At Memorial Hermann, were about creating exceptional experiences for both our patients and our employees. Our goal is to provide opportunities for our diverse employee population that develop and grow careers in a team-oriented environment focused on patient care. Every employee, at every level, begins their journey at Memorial Hermann learning about the history of the organization and its established culture built on trust and integrity. Our employees drive this culture, and we want you to be a part of it. Job Summary Responsible for the oversight of network management operations and provider relations for MHMD and the Memorial Hermann Health Plan. Reporting to the VP of Operations for MHMD, this role will have direct responsibility for the field staff that support the MHMD network providers, the staff that manage network data and roster integrity with payers, in addition to various strategic initiatives related to the ongoing management and refinement of the provider network, regulatory and compliance standards, and ongoing process improvement. Job Description Minimum Qualifications Education: Bachelors degree required; Masters degree in Business Administration, Healthcare Administration or related field preferred Licenses/Certifications: (None) Experience/Knowledge/Skills: - Seven (7) years of experience in operations, project management, or process improvement required - Three (3) years of supervisory experience required - Provider relations or managed care experienced preferred - Effective oral and written communication skills across all levels of leadership, front-line staff, and physicians - Ability to lead teams and drive change in collaboration with multiple stakeholders and departments - Strong presentation skills - Demonstrated leadership skills to successfully navigate conflict resolution - Demonstrates commitment to the Partners-in-Caring process by integrating our culture in all internal and external customer interactions; delivers on our brand promise of we advance health through innovation, accountability, empowerment, collaboration, compassion and results while ensuring One Memorial Hermann. Principal Accountabilities - Provides oversight of teams responsible for network management and provider relations within the physician organization (including MHMD network and health plan support). - Drives ongoing process improvement and change management to ensure regulatory requirements are met, exceptional service for provider network, data integrity, and efficient operations. - Develops strategies and recommendations to refine network, identify gaps, and ensure coordination across the system. - Ensures provider complaints and concerns are rapidly addressed and holds team accountable for appropriate resolutions. - Oversees network field representatives and ensures senior leadership team is aware of provider-related feedback, communication or identified issues. - Ensures staff is aware and understands all applicable payer, insurance, and network information to communicate effectively with physicians, practice staff, and internal stakeholders. - Oversees staff to ensure Memorial Hermann Health Plan meets provider access requirements as mandated by CMS, the Texas Department of Insurance or other regulatory agencies. - Provides oversight and participates in provider-related audit documents for STARs, HEDIS and other quality reviews of Memorial Hermann Health Plan. - Oversees provider-related policies and procedures for Memorial Hermann Health Plan. - Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service. - Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff. - Other duties as assigned.

Keywords: Memorial Hermann, Houston , Director, Provider Relations and Network Management, Executive , Houston, Texas

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