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 Lead CM Coordinator is the first line coach to the Care Management Coordinators overseeing workload, processes, procedures and productivity. The Lead position documents the companys meeting of and maintaining the quality standards of HHSC and URAC and have the ability to quickly and accurately resolve any issue raised by the coordinators or internal/external stakeholders.

MINIMUM QUALIFICATIONS:

  • Education/Specialized Training/Licensure: High School Diploma / GED required. Associate or Bachelors Degree may be used in lieu of experience.
  • Work Experience (Years and Area): Bachelors degree with 1-year experience; Associates with 3 yearsexperience or; 5 years customer service experience in healthcare setting such as a medical clinic, hospital, or managed care in lieu of degree. Medicaid coding preferred.  Managed Care Organization preferred.
  • Management Experience (Years and Area): Team lead and/or coaching experience preferred.
  • Software Operated: Microsoft Office (Word, Excel, Outlook)

SPECIAL REQUIREMENTS: 

  • Communication Skills:
  • Above Average Verbal (Heavy Public Contact)
  • Languages: Spanish preferred
  • Writing /Composing: Correspondence / Reports

Other Skills: Analytical, Medical Terminology,MS Word, MS Excel

  • Work Schedule: Flexible, Overtime
  • Other Requirements: Must be able to work independently under minimal supervision.
  • Excellent customer service skills, dependable, self-motivated, excellent communication skills, bilingual preferred.


 

Application Instructions

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