Associate Medical Director - 153890
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 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; some clinical input and oversight for Care (Disease) Management, Quality Improvement, Credentialing, and Preventive Medicine programs; working with Provider Relations to maintain and improve relationships with the provider community; and, other duties as assigned by the Senior Vice-President of Medical Affairs.
- MD or DO Degree and Licensure in the State of Texas, Completion of Residency and Board Certification with preference for the Primary Care Specialties. Master's Degree in Public Health, Business Administration or Medical Administration preferred.
- Three years clinical experience with one year of administrative experience in management of a private or group practice, facility, or other similar administrative experience such as physician reviewer or medical director in a facility or health plan.
- Familiarity with basic computer business programs, such as Word and Excel
- Above Average verbal communication skills
- Writing /Composing (Correspondence/Reports)
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.