Director, Network Operations

Community Health Choice, Inc. (Community) is a non‑profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

' Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

' Children's Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

' Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre‑existing conditions.

' Community Health Choice (HMO D‑SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high‑quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high‑risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self‑sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

The Director, Network Operations provides strategic and operational leadership for Community provider network operations, provider data integrity, regulatory reporting, provider communications, and related network‑support functions. The Director is accountable for establishing the operating model, governance standards, performance measures, and cross‑functional practices needed to maintain accurate provider information, timely and reliable regulatory submissions, effective provider communications, and consistent support of Community's provider network.

This position translates Network Management priorities into department strategies, annual objectives, performance expectations, and sustainable processes. The Director leads the interpretation and resolution of complex provider data, reporting, system, workflow, and compliance issues; oversees audit and regulatory readiness; and partners with Provider Contracting, Provider Engagement, Credentialing, Claims, Compliance, Information Technology, Quality, and other stakeholders to strengthen data quality, operational effectiveness, provider experience, and organizational decision-making.

Develop and execute the provider network operations strategy in alignment with Network Management and organizational priorities.

Establish department goals, operating standards, governance practices, service expectations, performance measures, and escalation protocols.

Provide strategic oversight of provider data integrity, regulatory reporting, provider communications, network coordination, and related operational support activities.

Evaluate operational risks, capacity, workflow dependencies, and performance trends; determine corrective actions and resource priorities.

Present network operations performance, risks, trends, and recommendations to the VP, Network Management and other leaders.

Direct governance and quality oversight for provider data used in claims, directories, regulatory submissions, network reporting, and operational decision‑making.

Ensure processes support accurate, complete, timely, and auditable state and federal reporting, including applicable Texas HHSC and CMS requirements.

Establish validation, reconciliation, quality review, issue management, and corrective‑action standards for provider data and regulatory reporting.

Oversee investigation and resolution of complex data…