About this role
We are searching for a Provider Relations Liaison, The Health Plan - someone who works well in a fast-paced managed care setting. In this position, you’ll plan, direct and maintain strategies that assure harmonious relationships are established and maintained with physicians and other providers and efficient, effective care is delivered within a discreet assigned territory. Additionally, you’ll educate providers through in-service programs that review policies and procedures physicians are obligated to adhere to, discuss physician feedback as necessary and promote continuing education classes and other educational programs that support the goals and objectives of the health plan.
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Job Duties & Responsibilities
• Develops and maintains strong business relationships with participating providers
• Responsible for development of a regional territory inclusive of provider selection and satisfaction as well as member growth and medical loss ratio
• Resolves managed-care issues and/or problems related to claims, medical management, or member services issues
• Identifies educational needs within the provider network and initiates educational efforts as needed or upon provider’s request
• Develops and follows territory strategic plan aligned to our organizational mission and vision
• Conducts territory assessment and develops strategic plan for service area based including interventions to meet growth projections of membership and influence medical loss ratio
• Assures that monthly and quarterly mailings to providers are completed according to departmental policies and procedures
• Assures that new providers receive a provider handbook within five (5) days of being added to plans
• Creates Community and Provider Satisfaction
• Represents Provider Relations at various meetings, both internal and external
• Creates community outreach opportunities for marketing and educational purposes within territory
• Ensures appropriate and thorough resolution of provider issues.
• Delivers exceptional service to participating providers in assigned geographic region
• Supports Regulatory and Operational Compliance
• Submits provider visits reports in accordance with departmental policies and procedures meeting weekly with manager
• Completes assigned projects including provider accessibility survey, after hours surveys, satisfaction surveys, newsletters, and updates to provider handbooks in a timely manner
• Ensure timely completion of all team projects, assignments, and job duties Develop project plans for team projects and assignments and serves as Team Leader for various special projects as assigned by applicable Manager
Qualifications & Requirements
• High School Diploma/GED or Bachelor’s degree preferred (In Health Care, Business or related field)
• A minimum of three (3) years of health care or managed care experience
Other facts
About Texas Children's Hospital
Texas Children’s Hospital is a world-class pediatric facility, nationally recognized as a top children’s hospital, and voted one of the best places to work in Houston for nine years running. We’re committed to creating a healthy community for children by providing the best pediatric care possible, through groundbreaking research and emphasis on education. We also offer a full continuum of family-centered care for women, from obstetrics to well-woman care. As a team member at Texas Children’s Hospital, you’ll work in an environment that values your voice. Texas Children's Hospital, headquartered in Houston, Texas, is recognized as one of America's best children's hospitals.
What you'll do
- The Provider Relations Liaison develops and maintains strong business relationships with participating providers while resolving managed-care issues. They also conduct territory assessments and create strategic plans to ensure effective care delivery.
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