Texas Children's Hospital

Assist members and providers with inquiries, resolve issues, and facilitate appeals in a healthcare managed care setting. | High school diploma or GED, with at least 3 years of customer service experience, preferably in managed care or insurance. | We are searching for a Senior Call Center Representative- someone who works well in a fast-paced setting. In this position, you will serve as a member and/or provider advocate that understands the organization's processes, policies, and procedures to investigate, resolve and/or facilitate the resolution of simple to complex issues/questions. You will be the first point of contact for assistance or information regarding eligibility, benefits, authorizations, claims, referrals and/or any other member/provider demands. Lastly, you will assist and advocate for members and/or providers throughout the complaint and appeal process and support members with timely appointment scheduling. Think you've got what it takes? Job Duties & Responsibilities Act as a secondary resource to Call Center Representatives in the absence of the Team Lead and responds to escalated calls and triages to management, if necessary Identify and handle a variety of routine to complex customer or prospect inquiries or requests Educate members about their health coverage benefits and services and empowering members/providers by directing them toward available resources for self-help Meet Senior Member Service Representative performance goals for customer satisfaction, quality, productivity, and all performance metrics Ensure all HIPAA and state privacy and confidentiality requirements/regulations are adhered to at all times File complaints and appeals on behalf of members and providers within the regulatory timeframe and in compliance with departmental policies and procedures Skills & Requirements High school diploma or GED Minimum of 3 years of customer service, call center, and/or experience within managed care or insurance industry or A Bachelor's degree may substitute for two (2) years of the required experience Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area. To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Coordinate credentialing, privileging, and medical staff activities ensuring compliance with regulations, and support medical staff and educational activities. | High school diploma or GED and 2 years of administrative, secretarial, or customer service experience. | We are searching for a Medical Staff Coordinator -- someone who works well in a fast-paced setting. In this position, you will coordinate administrative support and provide resources needed by and for the Medical Staff, Texas Children's IDS, and various regulatory agencies relative to the organized medical staff and its functions. Think you've got what it takes? Job Duties & Responsibilities Proficiently coordinates and processes all aspects of credentialing and privileging activities, ensuring compliance with Medical Staff rules and regulations, Serves as a resource in credentialing/privileging-related matters, such as: Initial applications, change in staff status, preparation of correspondence, reappointment applications, change in service, filing, temporary privileges, leave of absence, additional privileges, resignations, change in privileges, and managed care credentialing Acts as a resource for activity directors and coordinators of CME activities to ensure that the application materials meet established guidelines Facilitates the review of CME application materials by the CME committee members Oversees day-to-day operations of the Graduate Medical Education Office Assists residents and fellows with clinical learning environment onboarding. This may include but will not be limited to training, badging, network access, parking, and meal subsidies Proficiently coordinates all aspects of meetings, ensuring compliance with Medical Staff bylaws, rules and regulations. Meeting responsibilities may include any combination of the following: meeting chair support, coordination catering, preparation of minutes, agenda preparation, meeting notification, timely follow-up, reserve meeting space, and packet assembly/delivery Proficiently coordinates all aspects of the Focused Professional Practice Evaluation process, Ongoing Professional Practice Evaluation, and Professional Practice Evaluation processes ensuring compliance with established policies and procedures, and Joint Commission accreditation standards Maintains detailed knowledge of the provisions of the Medical Staff Bylaws, Rules & Regulations, and Policies and Procedures, and aids others regarding their content Assists in assuring that Medical Staff Bylaws, Rules & Regulations, and Policies and Procedures reflect current practice and follow Joint Commission and, as applicable, NCQA, and State and Federal regulations Accurately and efficiently handles all aspects of practitioner data to ensure data integrity and confidentiality Verifies that all licenses, certifications, professional liability insurance, are current and updated in the appropriate data system Skills & Requirements High School Diploma or GED 2 years' experience in administrative, secretarial, or customer service Texas Children's Hospital West Campus is Houston's first community hospital designed, built and equipped exclusively for children in one of the city's most rapidly growing communities in the area from Sugar Land to Bryan-College Station, Texas. Located at I-10 and Barker Cypress, our 515,007-square-foot hospital houses the only 24/7 pediatric emergency room in the Greater West Houston area, four operating rooms, 16-bed pediatric intensive care unit, 46 acute care beds, advanced imaging services including MRI and CT scans, a neurophysiology sleep lab, a pathology lab and a full-scale pharmacy. To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Develops and oversees population health strategies, manages social determinants of health programs, and collaborates with leadership to improve health outcomes. | Requires a bachelor's in nursing or social work, 5+ years of leadership, and 4+ years in population health or related fields. | Job Description We're searching for a Director of Population Health Operations and Clinical Support, someone who works well in a fast-paced setting. In this position, you'll develop and oversee a comprehensive population health management strategy to improve the health and wellbeing of STAR Kids and STAR/CHIP members, including social determinants of health. This position will help to define population health initiatives and create a structured, scalable approach to prioritizing and monitoring population health initiatives through appropriate outreach campaigns, health screenings and referral programs Think you've got what it takes? Job Duties & Responsibilities • Ensures STAR Kids timeliness measures are met for new member outreach and initial SAI timeliness • Ensures Member complaints are received timely, and all interventions and resolutions are appropriate • Ensures PDN/LTSS Specialty Care Team works collaboratively with internal and external partners and appropriate care delivery. Reduces avoidable costs of care • Creates and manages a population health strategy by identifying and addressing specific needs of STAR Kids and STAR/CHIP subpopulations. Integrates population health principles and evidence-based research to develop interventions • Through call campaigns, develops new and enhance existing interventions to improve HEDIS metrics, clinical outcomes, and reduce cost • Oversees development of social determinants of health program, including MCO outreach and partnerships with community organizations • Represents MCO as thought-leader and community partner for SDOH needs and healthy equity • Collaborates effectively with Executive Leadership and other leaders of the system. Utilizes presentation skills to demonstrate need and propose solutions • Communicates positively and appropriately to work effectively as a team. Provides appropriate information at the appropriate level and audience Skills & Requirements • Bachelor's degree in nursing or social work required • Master's degree in nursing preferred • 5 years of supervisory/formal leadership experience required • 4 years of progressively responsible professional experience in population health, community public health, ambulatory care, or healthcare administration required • Experience with NCQA accreditation process requirements preferred About Us Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area. To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Assist with patient data collection, vital signs, and collaborate with RNs to provide patient-centered care. | High school diploma or GED, completion of a clinical healthcare program or current enrollment in a BSN program, and at least one year of direct patient care experience. | We are searching for a Patient Care Assistant— someone who works well in a fast-paced setting. In this position, you will perform a variety of routine and specialized patient care activities, as assigned, under the direction and supervision of the Registered Nurse (RN). Care will be delivered that incorporates Family Centered Care cost-effectively and is developmental and age-appropriate for the patient population. Think you’ve got what it takes? Job Duties & Responsibilities • Assist with the collection and documentation of patient/family data • Obtains and documents vital signs (without the use of continuous physiologic monitors) and notifies professional of abnormal findings as evidenced by supervisory observation and review of medical records • Provide high-quality, cost-effective patient care in collaboration with the RN and in conjunction with the patient/family • Demonstrate ability to collaborate with multiple RNs in a professional manner to prioritize workload based on patient/family needs as evidenced by supervisory observation and verbal/written feedback • Assist in identifying patient/family response to care provided • Provide input to the RN for the development and ongoing modification of the plan of care, as evidenced by supervisory observation, verbal/written feedback, and review of the plan of care • Maintain accountability for development of self and participates in development of others • Demonstrate commitment to team, flexibility, professional interpersonal, communication, and customer service skills Participate in achieving hospital/unit goals • As part of our commitment to maintaining a safe and healthy workplace, all successful candidates will be required to undergo respiratory fit testing in compliance with occupational health and safety standards. Skills & Requirements • H.S. Diploma or GED Required • One of the following is required in addition to the high school diploma or GED: • Completion of a formal nursing assistant educational program or certification (e.g. • Diploma/Course/Certificate/associate degree/Etc. completed in a Certified Nurse Assistant, Medical Assistant, or similar clinical education program). • Currently enrolled in a BSN degree program with one clinical rotation completed at hire. • One (1) year of direct patient care experience.

Support and manage system optimization projects, analyze business practices and workflows, document processes, perform vendor analysis, and coordinate system training. | 7 years healthcare operations or IT experience, high school diploma or GED, with bachelor's or master's degree substituting for some experience. | Job Description We are searching for a Business Systems Analyst II -- someone who works well in a fast-paced setting. In this position, you will support and manage all phases of a system optimization or upgrade project and provides production services such as recommending improvements to strategy, system usage, or process through the application of business and technology skill sets. Reviews and analyzes programming systems including testing and documenting Epic applications. Consults with customers to identify current operating procedures and clarify program objectives. Additional responsibilities include workflow administration, data management, and performing minor modifications to the application. Think you've got what it takes Job Duties & Responsibilities • Collaborates with internal core stakeholders to identify system issues and process needs, • ensures EMR and other systems are being optimized. • Identifies system or application needs. • Conducts analysis of current business practices, user needs and workflow processes. • Documents the current as is & to be business processes. • Performs vendor analysis and makes recommendations. • Investigates alternative solutions including feasibility studies using results from vendor analysis/evaluations. • Uses data to identify trends, patterns, and opportunities for business/clinical operations. • Engages users in analysis and evaluation of functional models and prototypes; identify dependencies. • Supports business/clinical operations and serves as liaison to I.S. supporting continued system maintenance and optimization. • Works with I.S. and customers to perform functional configuration analysis for system implementations, ongoing maintenance, and other projects. • Analyze system problems and modifications. • Coordinates training of systems. Skills & Requirements • H.S. Diploma or GED • 7 years' experience in healthcare operations and/or information systems implementation, • Bachelor's degree will substitute four (4) years of work experience and a master's degree will substitute for two (2) years of work experience About Us Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area. To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Manage and direct a business operations team to ensure regulatory adherence, quality control, and performance metrics in reimbursement systems within a healthcare setting. | Bachelor's degree or equivalent experience, 5 years project management, 3 years management, and 3 years healthcare or MCO environment experience, with preferred medical coding certification. | Job Description We’re hunting for a Manager of Reimbursement Systems Configuration (telecommuter/remote), someone who’s ready to be part of the best ranked children’s hospital in Texas, and among the best in the nation. In this position, you will be responsible the for the day-to-day Operations of a Production driven team(s), maintaining State and Regulatory requirements along with departmental SLAs. Establishes, implements, and monitors quality control measures. Develops, tracks and reports performance, productivity metrics, proactively identifying trends and refocusing the direction of the team(s). Independently accesses workflows and processes for potential improvements and efficiencies. Works collaboratively with leadership and others from various areas across the health plan to evaluate and work cross functionally to implement new ideas and new strategies. Think you’ve got what it takes? Job Duties & Responsibilities Manages Business Operations Team Manage the work and the direction of the team Direct the Department standards to meet and then exceed any State Requirements Manages cross function work groups to create and implement best practices across multiple Departments Report out to Leadership and Executive Leadership with quantifiable metrics on the quality of the data Define the Department scope and review and sign off on policies and procedures Educate other departments on provider data use in all systems Establishes, implements, and monitors quality control measures related to process and/or system changes impacting reimbursement & benefits Applies regulatory and systems knowledge to ensure regulatory adherence for provider reimbursement Applies reimbursement, regulatory, payment integrity, and systems functional knowledge to ensure regulatory adherence for provider reimbursement Quality Management Coaching and developing Skills & Requirements Bachelor's Degree required Other Medical Coding Certificate Preferred 5 years Project management experience required 3 Years Management/Leadership Experience Required 3 years Healthcare industry or MCO environment required Four (4) years configuration, payment integrity, reimbursement experience can substitute a bachelor's degree About Us Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area. To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.