Manager, Provider Growth

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.

Job Summary

The Provider Growth Manager is responsible for driving membership growth through provider account management strategies. Expanding provider participation with our health plan and partners across assigned markets. This position is responsible for cultivating and nurturing positive relationships with Medicaid and Medicare providers and ensuring a seamless provider experience. In addition to these core functions, the Provider Growth Manager supports team process improvements, collaborates with cross-functional teams, tracks provider feedback to inform product development, and contributes to the development of marketing and education materials to foster provider engagement and membership growth

JOB SPECIFICATIONS

• Lead development and implementation of all growth initiatives including market evaluation of preferred provider organizations, select provider programs and associations.
• Manages, and leads assigned team, which includes the responsibility for recruiting, selecting, training, and coaching. Manager also does performance evaluations, oversees compliance, work allocation and problem resolution.
• Develop, update, and implement standard operating procedures for day-to-day business responsibilities. (Salesforce, data entry, data interpretation, documentation, visit reporting, issue resolution, event training, education for member/provider, platform training and utilization).
• Manage market team reporting by analyzing data to identify trends and patterns, outliers, and anomalies to escalate issues to appropriate internal business partners and/or leadership for resolution, as necessary. Plans, organizes, directs, executes, and reports on market, growth, and marketing strategies. (Market observations, membership growth, attrition, movement, retention, disenrollment, competitor allocations, provider membership growth and trending).
• Work with internal business partners to identify, understand, and/or improve tools, resources, systems, and capabilities that can maximize provider/member experience or health plan performance to support the coordination of integrated marketing efforts and share best practices. (i.e., health plan, Quality, M&R, LTSS, Member Advocates)
• Serve or appoint a team member to represent Community Health Choice at market meetings, forums, events, and conferences. (i.e., associations, work groups, panels, committees, sponsors, church, and community organizations).
• Make recommendations to leadership regarding sponsorship for special projects and subsequently, manage the end-to-end process.
• Actively contributes to achievement of departmental goals, as identified in
• Departments annual business plan, including specific departmental processes.
• improvement plans, and other duties as assigned.

QUALIFICATIONS:

• Education/Specialized Training/Licensure: Bachelors degree in business administration, Health Care Management, Marketing or a related field or 7 years' experience in lieu of degree required.
• Work Experience (Years and Area): 3+ years of experience in member, provider marketing and sales, provider relations or healthcare management required
• Experience leading and managing teams of 4 or more and in the field preferred.
• Strong leadership skills with the ability to manage cross-functional teams and influence outcomes.
• Proactive approach to identifying problems and implementing solutions in account management.
• Manage accounts that lead to membership growth.
• Strong presentation skills
• Software Proficiencies: Proficient in Microsoft Office Suite, CRM software, and other data analytics tools.
• Other: Familiarity with state and federal regulations related to Medicaid, Medicare, and Health Insurance Marketplace plans.