Credentialing Manager - Community Health Choice
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.
The Credentialing Manager is responsible for managing the initial credentialing, re-credentialing and the continuous credentialing processes for individual and organizational Providers; supervision of credentialing staff, maintenance of the integrity of Provider data in credentialing files and in the credentialing database, compliance with regulatory and accreditation standards. The manager is also responsible for performance expectations related to credentialing quality control, delegation oversight, departmental goals. The manager collaborates with fellow leadership, co-workers, and staff in other departments to achieve departmental and organizational objectives and to deliver exceptional Member and Provider Service. The manager also fosters an environment of continuous learning, staff development, and performance improvement through defined metrics.
- Bachelors degree in Health Care Administration or Business related discipline required.
- Four years of related experience may be substituted in lieu of the degree requirement.
- NAMSS Certification (CPCS or CPMSM) strongly preferred or eligibility to acquire within 12 months after date of hire
- Four years in the following areas: Hospital Credentialing, Health Plan Credentialing
- Two years of mangement in a credentialing setting.
- Writing /Composing(Correspondence / Reports )
- Analytical Mathematics
- MS Word MS Access
Please be advised: Effective Wednesday, September 1st, 2021, with the exception of those who receive an approved exemption, all new hires must provide proof of vaccination against COVID-19 or receive the first dose of a COVID-19 vaccine by the second Friday of employment.
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.
Community Health Choice (CHC)