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 a Registered Nurse the License Vocational Nurse (LVN) provides telephonic services to Community Health Choice (CHC) Members and their families for purposes of, identifying members with special health needs and available resource assistance.  Work with the member or the members legal representative to develop a service plan.  Monitor members with special healthcare needs as per HHS guidelines. Monitor members in the  Lock In and ED Programs.  Make referrals to other departments as needed.    Works closely with RN Case Managers, Team Leads and Managers of Care Management to coordinate care for members.  

MINIMUM QUALIFICATIONS:   

  • Education/Specialized Training/Licensure: License Vocational Nurse currently licensed in the state of Texas
  • Work Experience (Years and Area): 1 years managed care experience
  • Equipment Operated: Computer literate with knowledge of Word, Excel, and Outlook


SPECIAL REQUIREMENTS:   

  • Communication Skills: Above Average Verbal (Heavy Public Contract)
  • Bilingual Skills Required: Languages: Bilingual (English and Spanish) preferred
  • Writing /Composing Correspondence / Reports
  • Other Skills:  Medical Terms  P.C., MS Word, MS Excel  
  • Advance Training Specialty: License Vocational Nurse Certification
  • Work Schedule:   Flexible
  • Other Requirements: Microsoft Office Suite, filing, telephone skills, working independently.
  • Bilingual (English and Spanish) strongly preferred


RESPONSIBLE TO:  Director

EMPLOYEES SUPERVISED:  None

Application Instructions

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