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:

Day-to-day management and oversight of the Contracting & Provider Relations departments, including staff supervision.  Ongoing maintenance, review, and improvement of Communitys participating provider networks, including contract negotiations with hospitals, physicians, and ancillary provider for all Benefit Programs. Responsible for the timely and accurate administration of all participating Provider contracts and/or changes in demographic information relative to providers payments and/or directory listings.  Ongoing review and management of overall medical cost and quality associated with participating provider networks. On-going implementation, review, improvement of Communitys Provider Engagement Platform and Provider Education Plan. 

MINIMUM QUALIFICATIONS:

Education/Specialized Training/Licensure:

  • High School diploma or equivalent. 
  • Bachelors preferred.


Work Experience (Years and Area):

  • 4 years' experience with degree in the following areas: managed care, with at least 2 years, experience in contracting with physicians, ancillaries, hospitals;
  • 8 years related experience in lieu of degree.
  • Experience in value based contracting a plus.


Software Operated: Microsoft Office (Word, Excel, Outlook)

SPECIAL REQUIREMENTS: (Check Applicable Areas)
Communication Skills:

  • Above Average Verbal (Heavy Public Contact)
  • Writing /Composing   (Correspondence / Reports )


Other Skills:

  • Analytical
  • Medical Terminology
  • Statistical
  • MS Word
  • MS Excel




3. Advanced Education:

Bachelors Degree: Preferred


4. Work Schedule: Flexible

5. Other Requirements:  Must have car and valid Texas Driver's license.  Must have medical contract negotiations experience, preferably in Houston market.

RESPONSIBLE TO:  Director

EMPLOYEE SUPERVISED:

Technical/Professional (NE)
Professional (Exempt)

Application Instructions

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