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

The Network Analytics Manager is responsible for collection, aggregation, analysis, and presentation of decision support tools for Community Health Choices contracting department. Supports proposal and counter-proposal development, tracks financial performance of existing contracts and programs and ensures alignment with health plan budgets and forecasts. Contributes to innovative payment models that fundamentally improve the way that healthcare is delivered and reimbursed. Heavy emphasis on hospital contract modeling.


MINIMUM QUALIFICATIONS:

  • Bachelor's degree preferred in Healthcare Management, Statistics, Economics, Mathematics, Information Systems, or similar.
  • Four years of experience in business performance reporting, data analysis, and hospital contract modeling.
  • Two years management or team leadership experience.

 OTHER SKILLS:

  • Experience in a complex healthcare delivery environment, specifically with government-sponsored programs.
  • Familiarity with a variety of healthcare data, including claims, provider, utilization, and call center data.
  • Intermediate to excellent Excel and SQL knowledge.
  • Familiarity with Power BI tools.
  • Knowledge of QNXT and NetworX.
  • Deep understanding of payer-provider contracts that govern reimbursement and the healthcare revenue cycle.
  • Experience working in a fast-paced environment.
  • A personal, systematic approach to problem characterization and solution development.
  • Experience with value-based contracting models, including shared savings and risk-based arrangements.





 

Application Instructions

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