Senior Business Process Specialist

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