Skip to main content

TX STAR+PLUS Supervisor, Provider Relations

Primary Location: Dallas, TX
Additional Locations: TX-Dallas, TX-Ennis, TX-Grand Prairie, TX-Greenville, TX-Irving, TX-McKinney, TX-Plano, TX-Terrell
Apply
Description:
At Aetna Better Health of Texas, we are committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day. We are looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of Texas STAR+PLUS, STAR/CHIP, and STAR Kids members. We value diversity and are dedicated to helping you achieve your career goals.

This position is office-based with some travel required. Travel to provider and service area offices is required with a personal vehicle.

Responsible for the daily operation and direction of the external and internal Provider Relations staff. Supervises and trains employees who maintain working relationships with the existing provider network and assist in the recruitment of new providers. Ensures the accuracy of current provider databases relating to provider facilities and provider information. Assists with the establishment and interpretation of the department’s policies and procedures. Ensures compliance and regulatory requirements are met.


Fundamental Components:
Oversees the resolution of administrative problems affecting network providers, members and Plan within contracted guidelines; resolves problems and advises providers of new protocols, policies, and procedures.
Provides oversight of provider engagements.
Assesses departmental and provider training needs; develops and implements appropriate training programs.
Coordinates provider status information with member services and other internal departments.
Develops and motivates staff.
Initiates and communicates a variety of talent actions including recruitment, talent development, performance management, recognition and pay for performance.
Monitors staff performance, including weekly staff metrics; coaches and mentors’ staff on performance issues or concerns.
Attends leadership meetings as needed.
Required to communicate w/internal/external parties by phone/in person; may require travel to offsite locations.
Promotes and educate providers on cultural competency.
Interprets contractual requirementsincluding federal and state regulations and NCQA.
Performs other related duties as required.


Background Experience:
Undergraduate degree in a closely-related field OR an equivalent combination of formal education and recent, related experience.
Minimum of 3-5 years’ recent and related experience in benefits interpretation and provider networking.
Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.
Knowledge of ICD-9, ICD-10 and CPT codes desired.
Excellent analytical and problem-solving skills.
Strong communication, negotiation, and presentation skills.
Supervisory experience is preferred.
Previous experience managing teams with a proven track record to drive results and meet team metrics is a plus.
Previous experience leading in Government sector (i.e. Medicare and Medicaid) is preferred.
Project management; ability to manage and strive in a fast-paced environment with competing priorities.
Proficiency converting analytics into actionable items.


Additional Job Information:
Use of personal vehicle when traveling in the field, must have active and valid TX driver's license, reliable transportation and vehicle insurance.
At Aetna Better Health of Texas, we are committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day. We are looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of Texas STAR+PLUS, STAR/CHIP, and STAR Kids members. We value diversity and are dedicated to helping you achieve your career goals.

Technology Experience:
Aetna Application - QNXT, Database - Intuit QuickBase, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft SharePoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Potential Telework Position:
No

Percent of Travel Required:
50 - 75%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position.

Candidate Privacy Information:
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Apply

Jobs for you

Recently Viewed Jobs

You do not have any recently viewed jobs

Your Saved Jobs

You do not have any saved jobs

Sign up for Job Alerts

Join our Talent Community

At Aetna, a CVS Health Company, we are pioneering a total approach to health and wellness and we need talented candidates like you to join our team. Become a member of our talent community to be the first to know about career initiatives that match your skills and interests as they become available, in addition to details on upcoming events, networking opportunities, and news about Aetna, a CVS Health Company.

Join Our Talent Community

Sign up to receive information about job openings that are tailored to your skills and interests. Plus, get the latest career news from Aetna, a CVS Health Company.