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: Behavioral Health Utilization Manager will assist the overall Behavioral Health Program for Community Health Choice in the review of telephonic and faxed clinical information to authorize medically necessary inpatient and outpatient care, utilizing nationally recognized evidenced based clinical criteria or approved medical guidelines
MINIMUM QUALIFICATIONS:

Education/Specialized Training/Licensure: Master's Degree
LCSW, LMFT, or LPC unrestricted Texas license

Work Experience (Years and Area):
Two (2) years' experience in an acute psychiatric care setting.
Two (2) years' experience in utilization review in a managed care environment with Medicaid and Medicare members.

Equipment Operated: Computer literate with knowledge of MS Word, MS Excel, Outlook, and telephone systems.  Also able to navigate clinical platforms

SPECIAL REQUIREMENTS:

Communication Skills:
Above Average Verbal (Heavy Public Contact)
Writing /Composing  (Correspondence / Reports )

Other Skills:
Analytical
Dictation/Transcription
Medical Terminology
Research
PC
MS Word
MS Excel

Advanced Education: Master's Degree Major: Social Work or related field

Work Schedule: Flexible

Other Requirements: Able to work independently under general instructions and working within a team environment. Ability to self manage while working remotely


 

Application Instructions

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