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.

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

                                                                                                 PRN/Weekends- Saturdays/Sundays

This PRN Associate Medical Director provides support for Community Health Choice¿s medical management programs. This includes performing medical necessity reviews, with peer to peer interactions as needed; appeals of adverse determinations;

QUALIFICATIONS:

  •  M.D. or D.O. Degree and Licensure in the State of Texas, Completion of Residency and Board Certification with preference for the Primary Care Specialties
  • Two years prior managed care experience, to include proficiency in performing medical necessity reviews, benefit coverage reviews, and reviews of appeals of adverse determinations;
  • Experience with STAR, CHIP and Health Insurance Marketplace programs preferred;
  • Three years clinical experience


 Microsoft Office (Word, Excel, Outlook)


 

Application Instructions

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