Location:

Calmont Operations Building

Department:

Network Mgmt

Shift:

First Shift (United States of America)

Standard Weekly Hours:

40

Summary:

Coordinate and negotiate hospital, physician (IPAs, PPMs, individual providers, multi-specialty groups) and ancillary service agreements that are in accordance with corporate, health plan and State guidelines; Recruit and develop network for a region and set of providers; Lead assigned recruitments (i.e., physician, hospital and ancillary) and ensure they result in complete and accurate standard contracts that meet objectives; Facilitate and oversee to the provider set-up and contract configuration to ensure accurate claims adjudication; Initiate contact and identify potential providers by geographic and specialty needs and update database; Evaluate and monitor providers’ performance standards and financial performance of contracts; Develop contracting action plans; Coordinate with internal departments and contracted providers to implement and maintain contract compliance

Additional Information:

Education:

Bachelor's degree, with 5 years’ experience or Associate’s degree, 10 years’ experience working with healthcare providers, ancillary or hospital groups in a health plan setting preferred otherwise

Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena

Proven contract preparation skills, with an in-depth knowledge of Medicaid and other reimbursement methodologies

Excellent written and verbal communication skills 

Ability to manage multiple priorities in a fast-paced environment 

Proficiency in MS Office applications 

Experience working with healthcare providers, ancillary or hospital groups

Experience working with Texas Medicaid

Preferred Qualifications:

Contracting Certification

Provider Relations experience

Experience with ACO/Risk Contracting

Value based contracting experience

CRM experience

Project Management experience/certification

 

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.