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Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.

Primary Purpose

Responsible for establishing a strategic framework governing the provider engagement strategy, the approach to complex system negotiations, and end-to-end positive provider experience for all providers serving Medicaid including hospitals, professional groups and independent practices. Responsible for the daily operations of the department working collaboratively with other operational departments and functional business stakeholders to lead or support various Provider Service functions with an emphasis on education, outreach and resolving provider inquiries. Accountable for ensuring compliance with regulatory agencies and accrediting bodies. 

Minimum Specifications

Education

  • Bachelor's degree in business administration, healthcare administration, or other healthcare related discipline required.
  • Master's degree in business or healthcare administration preferred.

Experience

  • Eight (8) years of experience in healthcare operations, managed care finance, network development, or provider relations.
  • Four (4) years of experience working in Medicaid or a managed care organization.
  • Experience working with Texas Medicaid preferred.

Equivalent Education and/or Experience

  • Ten (10) years of experience in a Network Development / Provider Relations leadership position with Texas Medicaid may be considered in lieu of a bachelor's degree.

Certification/Registration/Licensure

  • None

Required Tests for Placement

  • None

Skills or Special Abilities

  • Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms.
  • Demonstrated ability to coach and influence for results.
  • Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization.
  • Strong analytical, negotiation, and reasoning skills.
  • Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals.
  • Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups.
  • Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities.
  • Solid understanding of Texas Medicaid (STAR, STAR Kids, STAR+PLUS, or CHIP) program, Affordable Care Act (ACA), National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual.
  • Proficient Microsoft Office and computer skills.

Responsibilities 

  • Strategy
  • Develop and implement strategic initiatives that support health plan goals.
  • Ensure effective communication of the business vision, strategy and goals to executive leadership and State Representatives.
  • Contributes as a key member of the senior leadership team to advance PCHPs goals, mission, vision and values.
  • Develop and implements a high performing network in collaboration with Population Health and Health Equity.
  • Develop cost of care strategies in partnership with finance and health economics leaders with a core focus on sustaining affordability and robust network access.
  • Serves as the market lead for all external affairs including regulatory matters, advocacy constituency, relevant vendor adoption coupled with traditional care delivery entities.
  • Analyze member and provider use patterns, including cultural needs and preferences to identify trends and develop strategies.
  • Network Development
  • Develops and implements provider contracting strategies to contain cost, improve member access and enhance provider satisfaction.
  • Provides oversight of contract negotiations with potential providers. Evaluates and negotiates contracts with providers in compliance with health plan contract templates, reimbursement structure standards and other key process controls
  • Oversees and continuously optimizes PCHPs care delivery model across Medicaid with expansion possibilities into Commercial (Exchange), Medicare and Medicare Advantage and Long-Term Services and Supports.
  • Integrates components such as efficiency, total-cost and quality metrics into a retooled approach to health system reimbursement design, enabling an effective transition from fee-for-service based methodology to strategic incentives that drive health outcomes.
  • Provider Relations
  • Establish and maintain strong business relationships with hospitals, physicians and ancillary providers to ensure the network composition includes an appropriate distribution of provider specialties.
  • Enables providers for maximum success and leads cohesive provider account management campaigns, in partnership with various internal teams, designed to optimize performance across value-based care agreements, oversee the effective adoption of digital tools and to streamline operational processes.
  • Build and/or perform provider training, education and communication for external providers, internal staff and other stakeholders.
  • Develop and implement initiatives to support provider engagement. 
  • Quality and Performance Improvement
  • Serve as an innovation and process improvement champion to foster best practices and approaches that facilitate continuous improvement. Effectively implement programs and changes that proactively support Parkland's Strategic Plan.
  • Measures, improves, and maintains network adequacy per HHSC and other standards related to time, distance, and access. 
  • Regulatory
  • Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations.
  • Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards.
  • Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary.
  • Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary.
  • Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies.
  • Ensures adherence to all HHSC obligations as outlined in the Uniform Managed Care Manual, Uniform Managed Care Contract, and other relevant documents related to PCHP's provider network.
  • Fiscal Management and Operating Budget
  • Operationally responsible for the financial performance of assigned area(s).
  • Promote activities to achieve operational efficiency.
  • Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets.
  • Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs.
  • Manage staffing levels within established targets.
  • Talent Management
  • Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve.
  • Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work.
  • Accountable for orientation, ongoing education and training, and competency verification for all employees.
  • Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends.
  • Timely completion of employee performance appraisals.
  • Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan.
  • Mentor, coach, and support direct reports with building teamwork, professional development, and education to achieve optimal performance and develop talent.
  • Ensure employee engagement survey participation rates and results meet established targets.
  • Mandatory requirements are completed timely by employees.
  • Required licensure, certification, and/or registry are current and in good standing for all employees
  • Employee performance is monitored and managed. Consult with the Office of Talent Management as appropriate regarding employee performance concerns and disciplinary action. 
  • Professional Accountability
  • Acts with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values.
  • Adheres to organizational policies, procedures, and guidelines.
  • Completes assigned training, self-appraisal, and annual health requirements timely.
  • Adheres to hybrid work schedule requirements.
  • Attends required meetings and town halls.
  • Recognizes and communicate ethical and legal concerns through the established channels of communication.
  • Demonstrates accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information.
  • Maintains confidentiality at all times.
  • Performs other work as requested that is reasonably related to the employee's position, qualifications, and competencies.• 

Job Accountabilities

  1. Identifies and analyzes the design of jobs, work processes, work flows, etc. for the area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals of the department and Parkland.
  2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
  3. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.
  4. Develops and monitors annual budgets that ensure the department has the necessary funds to carry out the goals and objectives that have been established for the department.
  5. Develops, implements, monitors, and revises annual goals and objectives for the department that support the missions and objectives of Parkland.
  6. Selects, trains, schedules, motivates, supervises, and evaluates employees making recommendations for disciplinary actions up to and including termination, to ensure maximum utilization of individual and group capabilities. Ensures that assigned employees receive opportunities to further their knowledge.

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status. As part of our commitment to our patients and employees’ wellness, Parkland Health is a tobacco and smoke-free campus.

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Confirmed 15 hours ago. Posted 22 days ago.

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