Job Description

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.

Skills / Requirements

JOB SUMMARY 

Responsible for working cross-functionally to support the organization in obtaining and maintaining NCQA Health Plan accreditation. This position uses knowledge of current NCQA Health Plan standards to work effectively with business owners to identify gaps and deficiencies between current processes and the requirements of accreditation standards and to assist in implementation of any necessary changes.

JOB SPECIFICATIONS 

Serve as a resource to business owners; responsible for maintaining current knowledge of NCQA Health Plan Standards, and ensuring the organization is up to date with current requirements.
Maintain accurate and up to date timelines and progress reports to assure the project stays on target and all milestones are met. Ensures management is updated and is notified as areas of risk/barriers are identified.  Coordinates with accreditation consultants and the assigned project manager
Conduct mock audits of the various areas within the scope of accreditation providing business owners with a written summary of the findings.
Maintain minutes of all accreditation committee meetings and support management in preparing for meetings including presentations, agendas and resource materials.
Coordinate cross functional workgroups within the organization to support accreditation efforts, including scheduling and facilitation. Maintain workgroup notes and update project plan activities.
Other duties may be assigned

Reports to Position Title: Sr, Manager NCQA Accreditation 

QUALIFICATIONS: 


Education/Specialized Training/Licensure: Bachelor's degree in business, Social Work, Health Care, Project Management or related field required

Masters preferred

Work Experience (Years and Area): 5 years of managed care with proven experience required.

Experience with NCQA Health Plan standards preferred

Quality Improvement or Project Management experience is preferred

Software Proficiencies: Microsoft Office (Word, Excel, PowerPoint, Outlook)

Other: Must be able to establish and maintain collaborative working relationships across the organization to meet accreditation standards

Able to communicate with business owners in ways to gain buy-in and support meeting accreditation standards.

Able to effectively and efficiently keep management updated and able to identify barriers and risks related to accreditation.

Proficient in annotating and uploading documents to the NCQA portal.

Application Instructions

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