Director, Network Management-Health Plan - Cook Children’s Health Care System : Job Details
Director, Network Management-Health Plan
Cook Children’s Health Care SystemJob Location : New York,NY, USA
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. Acts as the 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. Oversees and manages all physician, hospital, and ancillary provider relationships.
Education/Experience:- Bachelor's degree required; MBA preferred.
- Advanced training in healthcare, business, or a related field required.
- Five to ten years of operational experience in a healthcare organization, preferably in provider network management.
- Minimum of five years of team management experience.
- Proven success in establishing and maintaining positive relationships with healthcare providers and their staff.
- Working knowledge of HMO business operations, including utilization management, member services, claims, credentialing, and benefit plan interpretation.
- Experience in preparing and presenting information to individuals and groups. Attention to detail, excellent organizational, problem-solving, verbal, and written communication skills required.
- Strong customer service orientation and skill set.
- Ability to work independently and as part of an integrated team.
- Analytical thinking, organizational, conflict resolution, and facilitation skills.
- Team-oriented, performance-driven.
Cook Children's Health Plan
Cook Children's Health Plan provides vital coverage to nearly 120,000 people in low-income families qualifying for government-sponsored programs in our six-county service region. We offer health coverage for CHIP, CHIP Perinatal, STAR (Medicaid), and STAR Kids members in the Tarrant County service area, including Tarrant, Johnson, Denton, Parker, Hood, and Wise counties.
Cook Children's is an equal opportunity employer. We provide equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions, and privileges of employment, including hiring, job placement, training, compensation, discipline, advancement, and termination.
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