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
The Manager, Service Coordination will be responsible for the oversight of the daily operations and coordination related to the activities assigned to Service Coordination staff including daily team operations, internal and external departmental relations, and recruitment/evaluation of staff.  This role will be responsible for developing, coordinating, and enforcing systems, policies, procedures, and productivity standards. The Manager, Service Coordination will ensure staff are able to facilitate member and provider needs through entire case management cycle. Assist in reviewing and updating the clinical model as needed in collaboration with leadership.  Responsible for compiling and reviewing multiple reports on work function activities for statistical purposes, financial tracking purposes and for process improvement to identify trends, assist in financial forecasting, and make recommendations to leadership.

JOB SPECIFICATIONS AND CORE COMPETENCIES
Oversight of Service Coordination staff, including but not limited to, daily management of productivity, documentation and compliance audits, timecards, coaching, counseling, and staffing coverage.
Continuous monitoring of documentation turnaround times and timely assessment completion to include outreach efforts in order to maintain compliance with state regulatory requirements.
Oversees recruitment, training, and ongoing staff development.  Partner with Human Resources to ensure state regulatory requirements are met.
Completes reviews of assessments to determine appropriateness of requested services, as well as reviews any potential reductions or denials of services.
Tracks, trends and reports all data as it relates to Service Coordination programs to executive leadership.

  • Assist leadership in reviewing and updating clinical models as indicated or required.
  • Communicates all updates or changes in policies, whether verbal or written to the staff on a consistent basis to ensure consistency and accuracy in processes.
  • Perform in-person supervisory visits, including in-home visits as part of staff evaluation and monitoring.
  • Actively contributes to achievement of departmental goals, as identified in Department¿s annual business plan, including specific departmental process improvement plans and other duties as assigned.


MINIMUM QUALIFICATIONS:

  • Education/Specialized Training/Licensure: Unrestricted RN license in Texas required
  • RUG Certified required.
  • BSN CCM Certification preferred


Work Experience (Years and Area):

  • 6 years in healthcare, with at least 3 years experience in STAR+PLUS, managed care, case management, or Medicaid waiver services.
  • Management Experience (Years and Area): 2 years experience in management/ leadership role.


Software Proficiencies: Microsoft Office (Word, Excel, Access, Outlook)

Other:
Effective leadership and communication skills, with the ability to motivate and develop high-performing teams.

Problem-solving and decision-making abilities, with a customer-centric approach.

Ability to work effectively in a fast-paced, dynamic environment and adapt to changing priorities. 


Job Family/Job Title Competencies
Problem Analysis
Attention to Detail
Critical Thinking
Managing Conflict

Application Instructions

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