Senior Business Process Specialist

We are searching for a Senior Business Process Specialist -- someone who works well in a fast-paced 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 Childrens 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 Childrens Health Plan and Texas Childrens. 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 Childrens Health Plan.

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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 Childrens 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 Serve as a trusted advisor to project and operational leaders by translating data driven insights into defensible recommendations.
Lead complex process improvement initiatives using descriptive diagnostic predictive and/or prescriptive analytics to deliver measurable operational gains.
Drive future state process and solution design sessions used to advise senior leaders on risks trade offs and sequencing for new processes and process redesigns leveraging Lean Six Sigma (DMAIC DFSS DMADV) and organizational change management best practices.
Guide organizational change readiness by fostering strong cross functional collaboration and applying robust quality assurance practices.

Skills & Requirements
Required Bachelors Degree with a preferred Masters 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 Masters degree in Business Health Care Administration Public Health Nursing MIS or an IS-related field may substitute for 2 years of the required experience