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

JOB SUMMARY:

Under the direction of the Behavioral Health Program Manager, functions as a Utilization Management Coordinator in the Medical Affairs department.  Primarily responsible for the initiation of cases by data entry of clinical, demographic and product information into the Medical Management system, via telephone, fax or online portal. . Electronically routes cases to the nurse for review and decision.  Handles data entry of all precertification of BH inpatient and outpatient service request. Responsible for accurate case completion /quality and productivity standards while staying within compliance timeframes

MINIMUM QUALIFICATIONS:

  • Education/Specialized Training/Licensure: Bachelors Degree in Sociology, Social Work or Psychology  or related field (preferred)
  • Work Experience (Years and Area): Three (3) years experience in a healthcare setting such as medical clinic, hospital, and managed care facility
  • Equipment Operated: Advanced PC Skills, MS Word, MS Excel, MS Outlook


SPECIAL REQUIREMENTS: 

  • Communication Skills: Exceptional Verbal (e.g., Public Speaking) Writing /Composing Yes  (Correspondence / Reports  )
  • Other Skills: Analytical , Medical Terminology, PC, MS Word , MS Excel 
  • Advanced Education: Advanced Training Specialty: DSM-V knowledge preferred
  • Work Schedule
  • Weekends 
  • Flexible 

Other Requirements:
Able to work independently under general instructions
RESPONSIBLE TO:
Supervisor/Manager 
EMPLOYEE SUPERVISED:
None 

Application Instructions

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