Manager, Behavioral Health
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.
JOB SUMMARY
The Manager, Behavioral Health is responsible for the day-to-day operational management of the Behavioral Health team and supports the Director, Behavioral Health in the administration of clinical operations, quality activities, staff oversight, and regulatory compliance. This role oversees implementation of case management and utilization management workflows for Behavioral Health, serves as a clinical resource for staff, supports policy and procedure implementation, and helps monitor operational performance, productivity, and service standards.
The Manager provides direct oversight of assigned staff and helps ensure work allocation, staff utilization, and team engagement remain aligned with departmental expectations.
JOB SPECIFICATIONS AND CORE COMPETENCIES
Department Management
Supervises day-to-day operations of the Behavioral Health team to support productivity, quality, and service expectations
Monitors staff assignments, daily workflow, pended cases, and workload distribution to support timely case management and utilization management operations
Reviews productivity and operational reports and escalates trends, barriers, and resource concerns to department leadership
Conducts routine audits of UM/CM staff and coordinators. Increases audit frequency when performance indicators, compliance concerns, or quality findings warrant additional oversight
Coordinates clinical rounds and coaches staff in preparing case summaries and presenting cases
Supports onboarding, orientation, and ongoing training for assigned staff
Provides operational support during staffing shortages or high-volume periods
Cross-functional Duties
Communicates operational issues, staff trends, and process opportunities to the Director, Behavioral Health and assists with follow-up actions as needed
Investigates and helps resolve claims, authorization, and workflow issues within scope and escalates complex matters appropriately
Cross-functional Duties
Communicates operational issues, staff trends, and process opportunities to the Director, Behavioral Health and assists with follow-up actions as needed
Investigates and helps resolve claims, authorization, and workflow issues within scope and escalates complex matters appropriately
Monitors turnaround time compliance for UM and CM processes and works with staff to mitigate and prevent non-compliance
Coordinates and monitors referrals to medical case management, high-risk perinatal, disease management, and quality improvement teams when appropriate
Supports staff in discharge planning needs of hospitalized members
Supports staff with clinical presentations to medical directors
Participates in departmental workgroups, committees, and initiatives to improve the health and quality of clinical care and service delivery to Community members and providers
Actively contributes to achievement of departmental goals, as identified in the department annual business plan, including specific departmental process improvement plans, reporting support, staff development activities, and other duties as assigned
QUALIFICATIONS:
Education/Specialized Training/Licensure: Master's degree in social work or counseling required. Current unrestricted license in the state of Texas: LCSW, LMSW, LMFT, or LPC required.
Work Experience (Years and Area): 5 years of combined case management and utilization management experience
Management Experience (Years and Area): 2 year of direct supervisory, team lead, or management experience in a managed care environment.
Software Proficiencies: Advanced PC skills, MS Word, MS Excel, MS Outlook