Senior Manager,Care Management
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 Senior Manager, Care Management supervises all Care Management functions for Community Health Choice and its members in the Care Management program. in the enrollment and ongoing outreach to CHC members and care-coordination to members in the care management programs. The Senior Manager reviews all programs annually and works with Medical Affairs staff and senior leadership to update program goals and content. In addition, the Senior Manager will identify other conditions for which CHC should prepare a care management program.
The Senior Manager will also work with Analytics and Medical Affairs staff/management team to ensure that 1) members are being contacted and enrolled appropriately; 2) program results, including ROI when measurable, are reported on a quarterly basis; 3) program problems are identified; and 4) process improvements are recommended and implemented.
- BSN degree with active Texas RN license.
- MBA, MPH, MHA and MSN preferred.
- Certification in Case Management (CCM) required or must receive within 18 months of employment.
- Two years’ experience in Care Management or Population Health required in a Managed Care environment.
- Two – four years supervisory or leadership experience, required.
- Experience with working with applicable state, federal and third party regulatory agencies ie. CMS, HHSC, TDI, Medicaid or Medicare programs.
- Experience working with NCQA standards preferred.
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.