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

The Director, Credentialing provides leadership, management, and operational oversight of the credentialing program, including the initial credentialing, re-credentialing, and continuous credentialing processes for individual and organizational provider types. The Director, Credentialing is accountable for performance expectations related to credentialing quality controls, delegation oversight, and department and organizational goals.  Additionally, the director is responsible for fostering an environment of continuous learning, staff development, and performance improvement through defined metrics, ensuring all departmental processes and output consistently adhere with  CMS,  HHSC, TDI, and accreditation requirements.
 

QUALIFICATIONS:

  • BA in Business, Healthcare Administration, or related field.
  • Five years of Health Plan credentialing experience in the past ten years.
  • Three years in a management position.
  • CPCS or CPMSM Certification preferred

OTHER SKILLS:

  • Exceptional Writing /Composing (Correspondence/Reports)
  • Analytical, Mathematics, Medical Terminology
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Application Instructions

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