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 Utilization Management Nurse Team Lead assists with oversight of the Utilization Management clinical staff, including but not limited to, monitoring process work flows and proposing process improvements to better meet contractual and regulatory requirements.  Oversees daily management of the Utilization Management (UM) clinical staff in regards to daily productivity, appropriate staffing, and timecard review when delegated. Daily review of nurse work queues to ensure that the regulatory turnaround times and deadlines are met for all lines of business (LOBs).  Coordinates with management to review and discuss trends and patterns in preparation for monthly meetings and to assist with ensuring consistency and accuracy in UM functions.


  • RN, current Texas License required.  BSN preferred.
  • Three years clinical experience and two years managed care experience in Utilization Management Department


  • Writing /Composing: Correspondence /Reports
  • Analytical, Medical Terminology, MS Word, MS Excel
  • Demonstrate the ability to utilize critical thinking to accomplish goals. 


Application Instructions

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