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:

  • The Chief Medical Officer (CMO) has accountability for the clinical strategy for Medical Affairs, Quality, and Medical Management all while building sustainable programs that promote innovative ways to achieve improved outcomes for our members.  These responsibilities include care management oversight, quality/STAR rating improvements, appropriate utilization, health system transformation and implementation of medical programs/policies, enhancing relationships with providers and facilities, industry policy advocacy, and regulatory agencies.
     
  • The CMO for Community Health Choice will be responsible for driving excellent results for all clinical affordability, quality, population health, growth, Net Promoter Score, and external relationship initiatives.  Additional plan medical directors, pharmacy, quality, and others report to this position.  The Chief Medical Officer reports to Community's CEO.

 

QUALIFICATIONS:
 

  • Education/Specialized Training/Licensure: MD Degree or DO and Licensure in the State of Texas, Completion of Residency and Board Certification in Family Medicine, Internal Medicine, Pediatrics or OB/GYN with preference for the Primary Care Specialties
     
  • Work Experience (Years and Area): Twelve years clinical experience with 5 years of administrative experience in Managed Care, including management of other physicians and/or clinical staff; Master's Degree in Public Health, Business Administration or Medical Administration preferred.
     
  • Management Experience (Years and Area): 5 years of administrative experience in Health plan management, including management of other physicians and/or clinical staff.
     

 

SPECIAL REQUIREMENTS:
 

  •  Communication Skills: 
    Above Average Verbal (Heavy Public Contact) 
    Exceptional Verbal (e.g., Public Speaking) 
    Writing /Composing: Correspondence/ Reports
     
  • Other Skills: Analytical, Medical Terminology, Statistical 

     
  • Advanced Education: 
    Master's Degree: Public Health, Business Administration or Medical Administration preferred
    Doctorate Major: MD or DO
     
  •  Work Schedule: Flexible 
     
  •  Other Requirements:
    Previous Medicaid Managed Care experience working with state regulators and executing on strategic initiatives and programs preferred. Strong leadership experience, strategic vision and a proven ability to execute on clinical initiatives are a "must have" in this position.

    RESPONSIBLE TO: CEO 

    EMPLOYEE SUPERVISED: "VP Medical Affairs / Operations ; Pharmacy, Quality, other Program Directors and 
    Clerical staff

Application Instructions

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