Director, Provider Engagement

About Us

Community Health Choice, Inc. (Community) is a non-profit Managed Care Organization (MCO) licensed by the Texas Department of Insurance. Through its network of over 10,000 providers and 94 hospitals, Community serves over 400,000 members with various programs including Medicaid, CHIP, Health Insurance Marketplace Plans, and a Medicare Advantage Dual Special Needs plan.

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.

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.