Job Description

Job ID
156547
Location
CHC - Central Campus
Hiring Range:
Annual Minimum to Midpoint:
0.00
-
0.00
Full/Part Time
Full-Time
Regular/Temporary
Regular

About Us

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.

Job Profile

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. 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.

QUALIFICATIONS:

  • RN, current Texas License required
  • Two years hospital experience and two years managed care experience

OTHER SKILLS:

  • Microsoft Office (Word, Excel, Outlook)
  • Writing /Composing: Correspondence /Reports
  • Analytical, Medical Terminology
  • Demonstrate the ability to utilize critical thinking to accomplish goals.


Please be advised: Effective Wednesday, September 1st, 2021, with the exception of those who receive an approved exemption, all new hires must provide proof of vaccination against COVID-19 or receive the first dose of a COVID-19 vaccine by the second Friday of employment.

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.

Job Category

CHC Clinical

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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