Job Description

Job ID
154889
Location
CHC - Central Campus
Hiring Range:
Hourly Minimum to Midpoint:
22.01
-
28.65
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 Appeals Nurse LVN facilitates all retrospective reviews, and medical appeals according to Texas HHSC, URAC, and Community Health Choice appeal policy. Assists in the tracking and trending of retrospective reviews, claim appeal issued and medical appeals. Performs all reporting functions for appeals internally, contractually, and for regulatory agencies.

QUALIFICATIONS:

  • LVN, current Texas License
  • One year of experience utilizing evidence based criteria in medical reviews;
  • One year in acute care setting or managed care setting preferred


Other skills

  • Analytical, Medical Terminology, MS Word, MS Excel


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.

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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