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 daily oversight and management of the Medical Affairs Coordinator Team which includes but not limited to managing the incoming fax volume, data collection, reporting and analysis of the teams performance and statistics. Management of planning and scheduling to include forecasting of fax volume and proper staffing levels across multiple lines of business. Directs intraday management of scheduling and analysis of real time workload requirements and fax triaging to meet regulatory service level requirements. Responsible for maximizing efficiency and occupancy while meeting all contractual obligations. Recognizes and recommends operational improvements.

JOB SPECIFICATIONS AND CORE COMPETENCIES

  • Manages daily operations of Medical Affairs paraprofessional teams, including by not limited to prior authorizations data entry, intake of inpatient clinical information and notice of admissions, approval process, and letter generation process.
  • Review documentation to assure compliance with Medicare, Medicaid and all regulatory agencies.
  • Review, prepare and submit reports to appropriate regulatory agencies.
  • Supports Medical Affairs for contractual provisions and in compliance with: HHSC, TDI, CMS, accreditation guidelines and internal quality improvement standards.
  • Implement and maintain policies and procedures.
  • Assist in identifying and implementing departmental and inter-departmental improvement opportunities to ensure appropriate fiduciary control and departmental performance efficiency.
  • Direct oversight of departmental staffing levels, training, development and mentorship and ongoing performance feedback; including development and review staff productivity standards, workflow procedures, protocols and overall departmental needs.
  • Provides input and/or feedback in the annual departmental budget and monitors expenditures to meet administrative cost targets.
  • Actively fosters and engages in efforts to ensure a culture of collaboration and teamwork in Communitys Leadership team and all staff.
  • Fosters an environment of continuous learning, staff development, and performance improvement through defined metrics.
  • Actively contributes to achievement of departmental goals, as identified in Departments annual business plan, including specific departmental process improvement plans.


Other duties as assigned.

MINIMUM QUALIFICATIONS:

  • Education/Specialized Training/Licensure: Associate degree required with 5 years health plan experience; or BS with 3 years experience; or  unrestricted LVN with 6 years experience or RN license in the state of Texas with 5 years experience required.
  • Bachelors degree in healthcare administration Public Health or related field preferred.
  • Work Experience (Years and Area): Depending on degree or licensure up to 6 years  health plan experience required.
  • Management Experience (Years and Area): 2 years Supervisory
  • Software Proficiencies: Microsoft Office (Word, Excel, Outlook)
  • Visio, PowerPoint, SharePoint preferred.

Application Instructions

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