Director Health Plans - Health Plan Admin in Irving, TX

Job Description | Job Attributes

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External Applicant Current Associate

Summary:

The Director of Health Plans/Network Contracting is responsible for collaborating across organization in the creation and execution of the network strategy for all US Family Health Plan and CHRISTUS Health Plan product lines. This position provides leadership and guidance to cross-functional areas and works closely with health plan and population health staff to implement changes or improvements to process and technology design. A high degree of professionalism is required due to the interaction with both internal and external contacts. This is a key role in defining, establishing and implementing strategic business design, architecture and functionality for the CHRISTUS Health Plans.

Responsibilities:

• Leads negotiations and guide contractors throughout the contract negotiation process.
• Ensures that the networks and supporting contracts are in compliance with standards, reimbursement, legal, financial, quality, etc., controls.
• Ensures health plan compliance with regulatory network requirements by monitoring network adequacy and identifying recruitment opportunities.
• Ensures providers are accurately and timely loaded into provider databases.
• Oversees the development of reimbursement models in concert with senior leadership. Communicates new strategies for consideration.
• Oversees the development of provider contracting strategies, identifying those specialties and geographic locations where network expansion is necessary.
• Oversees the maintenance of all Provider Contract Templates. Works with legal and Executive Director on an as needed basis to modify contract templates and ensures compliance with all contractual and/or regulatory requirements.
• Utilizes standardized contract templates and Pay for Performance strategies.
• Responsible in maintaining strong business relationship with the hospital systems and large provider groups.
• Leads the CHRISTUS Health Plan into a high-performing organization through routine measurement review of high priority metrics.
• Develops managers of multiple business units to add stability and consistency in CHRISTUS Health Plan operations.
• Assists plan leadership in developing and establishing the business strategic direction to meet requirements and goals.

Requirements:

Work Schedule:

8AM - 5PM Monday-Friday

Work Type:

Full Time