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 Manager, Compliance - STAR+PLUS is responsible for managing and overseeing the HHSC STAR+PLUS program to ensure compliance with laws, regulations, and contractual requirements. This position requires in-depth knowledge of STAR+PLUS, including developing policies and procedures to comply with this Medicaid managed care program for adults with complex medical needs. The Manager will provide leadership, guidance, and education company-wide to ensure compliance with policies, procedures, and deliverables related to STAR+PLUS. Strong collaboration, communication, and interpersonal skills are required.


Compliance lead for developing, implementing, and evaluating company-wide effectiveness of STAR+PLUS program related functions.

Develop training material and conduct internal / external stakeholder training sessions as necessary.

Collaborate with internal operational areas on matters related to regulatory reporting, audits, and corrective action plans related to STAR+PLUS.

Develop, implement, and manage Compliance policies and procedures for STAR+PLUS and collaborate with the Policies and Procedures team to ensure accuracy of regulatory requirements and citations.

Analyze and evaluate information related to the healthcare regulatory environment by monitoring appropriate state, federal and industry channels, and participating in workgroups as applicable.

Monitor and assess compliance risks with state and federal regulations related to STAR+PLUS and develop strategies to mitigate risks. Timely and accurately communicate compliance-related information to operational areas, Director, and Chief Compliance Officer.

Other duties ass assigned.


  • Education/Specialized Training/Licensure: Bachelors degree in healthcare administration, business administration or related field required.
  • Masters degree in business or healthcare related field preferred.
  • Work Experience (Years and Area): 5-7 years of experience in healthcare compliance, with a focus on the STAR+PLUS program and managed care.
  • Experience working with regulatory agencies.
  • Management Experience (Years and Area): Minimum of 2 years of management, supervisory experience, leading projects and conducting training.   
  • Software Proficiencies: Standard Office Software (Microsoft)


Application Instructions

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