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: 

Perform duties related to the day-to-day operations of the Behavioral Health Team.  Case Management works with high risk Members to help identify needs and goals to achieve empowerment and improved quality of life for both behavioral and physical health issues. Assessed Members current functional level and, in collaboration with the Member, develops and monitors the Case Management Care Plan, quality of care; assisting with discharge planning, participating in special clinical projects and communicate with departmental and plan administrative staff to facilitate daily operations of the Behavioral Health Case Management functions. Collaborate with both medical and behavioral providers, often onsite at hospitals or in the community, to ensure optimal care for Members. Work telephonically with patients and their Legal Authorized Representative identified as high risk, for both behavioral and physical health issues, and their providers to identify needs, set goals and implement action steps towards achieving goals. Understand and comply with NCQA/ URAC guidelines and HEDIS measures.

MINIMUM QUALIFICATIONS:

  • Education/Specialized Training/Licensure: Master's Degree in Social Work or Counseling
  • Current unrestricted license in the state of Texas: LCSW, LMSW, LMFT or LPC
  • Work Experience (Years and Area): 2 years experience in managed care or hospital setting and 2 years in behavioral health case management preferred
  • Equipment Operated: Advanced PC knowledge, MS Word, MS Excel, MS Outlook, and excellent telephone skills.


SPECIAL REQUIREMENTS: 

  • Communication Skills: Above Average Verbal (Heavy Public Contact) Exceptional Verbal (e.g., Public Speaking) Writing /Composing Yes (Correspondence / Reports)
  • Other Skills: Medical Terminology, Typing, PC, MS Word, MS Excel
  • Advanced Education: Advanced Training Specialty: LMSW, LCSW, LPC, Master's Degree Major: Social Work or Counseling
  • Work Schedule Flexible, Travel
  • Other Requirements: Excellent organization, coordination, and multi-tasking skills and abilities. Ability to organize and prioritize tasks and work independently. Strong attention to detail and deadlines. Will travel locally to hospitals as requested by manager or medical director when high risk or high utilizing member is inpatient.


RESPONSIBLE TO:
Supervisor/Manager

EMPLOYEE SUPERVISED:
None

Application Instructions

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