Senior Business Process Specialist - The Health Plan

Job Description We are searching for a Senior Business Process Specialist someone who works well in a fast-paced setting. In this position, you will develop and implement strategies to ensure optimal organizational operations that support the development and maintenance of a network of hospitals, physicians, and other healthcare providers who provide care to the members of the Texas Children's Health Plan and to continually develop management programs in response to analysis and research of managed care trends and benchmarks as well as the strategic goals of Texas Children's Health Plan and Texas Children's. To support and develop programs aligned with Health Plan strategic goals through effective and timely assessment and equitable distribution of resources and assignments, education and implementation of processes and procedures that provide and maintain a cost-effective provider network for Texas Children's Health Plan. Think you've got what it takes Job Duties & Responsibilities Plan, develop, organize, direct, and implement a coordinated approach to ensure regulatory adherence for provider network operations. Assures that TCHP meets the obligations of contractual agreements with HHSC, TDI, NCQA, and legislative regulations as it pertains to contracts with hospitals, physicians, and other healthcare providers Provides network operations oversight, and analysis of network services, trends, complaint findings, and growth strategies. Interfaces with internal TCHP departmental management staff and other personnel to resolve issues and complaints in a timely manner Develops approaches, policies, and programs for network operations and ongoing network development which are based on the Texas Children's goals and objectives, and which meet TCHP performance goals Supports the delivery of cost-effective, community-based, and culturally sensitive health care with specific emphasis on network operations that promote best member outcomes and provider satisfaction Skills & Requirements Required Bachelor's Degree with a preferred Master's Degree in Business, Health Care Administration, Public Health, Nursing, MIS, or an IS-related field Required 4 years of Experience in a managed care organization (MCO) or related healthcare organization and preferred 5 years of master Proficiency in SQL, MS access, and data analysis within an MCO or healthcare organization A Master's degree in Business, Health Care Administration, Public Health, Nursing, MIS, or an IS-related field may substitute for 2 years of the required experience About Us Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area. To join our community of 14,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.