Job Description

Job ID
152250
Location
CHC - Central Campus
Hiring Range:
Annual Minimum to Midpoint:
180000.00
-
245000.00
Full/Part Time
Full-Time
Regular/Temporary
Regular

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 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.

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 Profile

The Associate Medical Director is a key member of the medical management team and will be responsible for providing physician leadership in Medical Affairs. This role collaborates with other medical directors, nursing, pharmacy, and quality staff; including but not limited to Quality Management, Utilization Management, Care and Disease Management, Pharmacy and Behavioral Health. The Associate Medical Director performs concurrent and pre-service reviews, peer to peer discussions; appeals in accordance with regulatory standards, evidence-based guidelines and organizational policies. Clinical input and oversight for Care (Disease) Management, Quality Improvement, Credentialing, and Preventive Medicine programs while working with Provider Relations to maintain and improve relationships with the provider community.

QUALIFICATIONS:

  • MD or DO Degree and Licensure in the State of Texas, Completion of Residency and Board Certification with preference for the Primary Care Specialties.
  • Five years clinical experience with one year of managed care utilization review experience or other similar administrative experience such as physician reviewer or medical director in a facility or health plan.

OTHER SKILLS:

  • Above Average/Exceptional Verbal (Heavy Public Contact)
  • Writing /Composing: Correspondence/Reports
  • Analytical, Medical Terminology, MS Word, MS Excel



Benefits and EEOC

Community employees’ benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and choices in meeting your specific needs.

Community is an Equal Opportunity Employer.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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