Director, Provider Engagement

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 Director, Provider Engagement is responsible for leading the health plan's provider engagement strategy, provider relationship management, practice transformation initiatives, and performance optimization efforts across assigned provider networks. This leadership role drives provider collaboration to improve regulatory compliance, access to care, cost, quality, and Member outcomes.

The Director serves as the executive relationship lead for physician groups, health systems, ancillary providers, and key network partners, ensuring alignment between contractual requirements and organizational goals. The role oversees provider education, issue resolution, department performance indicators, value-based performance training, compliance training, operational readiness, provider-focused strategic initiatives, and provider satisfaction.

Strategic Planning

Develop and execute enterprise provider engagement strategies aligned with organizational goals, network performance objectives, and market priorities.

Serve as executive relationship leader for high-priority provider organizations, physician groups, and strategic health systems.

Partner with Provider Contracting, Network Operations, Medical Management, Quality, Claims, Credentialing, and Operations to drive provider performance.

Identify provider network gaps, access concerns, operational inefficiencies, and improvement opportunities.

Lead provider segmentation strategies and engagement models based on market, specialty, performance, and contractual priorities.

Provider Performance, Education, and Practice Transformation

Lead quality and value-based provider performance educational sessions.

Establish strategic improvement plans with provider partners.

Oversee practice transformation initiatives and operational redesign efforts.

Monitor provider scorecards, dashboards, and corrective action initiatives.

Executive Provider Relations and Network Performance

Serve as senior liaison between providers and internal business units.

Lead executive-level provider meetings, joint operating committees, and governance forums.

Drive implementation of strategic initiatives impacting provider network performance.

Partner with analytics teams to develop provider performance insights and action plans.

Support market expansion, network optimization, and transformation initiatives.

Department Leadership and Team Development

Lead, mentor, and develop Provider Engagement leadership and field-based teams.

Establish departmental performance standards, productivity expectations, service-level expectations, and accountability measures.

Build succession planning and team development strategies.

Foster a culture of provider partnership, responsiveness, and operational excellence.

Provider Operations, Issue Resolution, and Data Governance

Provide leadership over provider relations operational workflows, issue resolution, and service excellence.

Ensure timely provider issue resolution related to claim payment issues, credentialing concerns, provider portal functionality, and operational barriers.

Provide oversight for provider directory requirements and related data governance activities.

QUALIFICATIONS

Education/Specialized Training/Licensure: Bachelor's degree in Business Administration, Healthcare Administration, Public Health, or a related field required.

Work Experience (Years and Area): Ten (10) years of managed care or healthcare experience, including at least five (5) years of provider engagement, provider relations, or provider contracting experience.

Health plan experience and experience within the Houston market.

Management Experience (Years and Area): Five (5) years of direct people leadership experience.

Software Proficiencies: Microsoft 365 Suite.

Experience with QNXT and Salesforce.