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.

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

                                                                              PRN Position - No Benefits

                                                              Flexible/Evening & Weekend Hours

The Behavioral Health Associate Medical Director (PRN) is responsible for providing clinical guidance and consultation to the Behavior Health Case Management and Utilization Management/Appeals Teams. The Behavior Health Associate Medical Director will facilitate integrated Behavioral Health rounds and interact directly with psychiatrist, BH providers, and other clinical professionals.  Additonally, the Behavioral Health Associate Medical Director is responsible for timely coverage determinations, medical necessity reviews and appeals, peer-to-peer discussions and consultations with healthcare providers.  The BH AMD will work collaboratively with Chief Medical Officer, Physical Health Associate Medical Directors and other clinical staff.
 

QUALIFICATIONS:

  •  M.D./D.O., holds licensure in the State of Texas, Completion of Residency and Board Certification in Child/Adolescent and Adult Psychiatry. Must meet credentialing criteria.
  • Two  years prior managed care experience, to include proficiency in performing medical necessity reviews, benefit coverage reviews, and reviews of appeals of adverse determinations preferred;
  • Five years clinical experience required.

OTHER SKLLS:

  • Microsoft Office (Word, Excel, Outlook)
  • Exceptional Verbal (e.g., Public Speaking)
  • Writing/Composing: Correspondence/Reports
  • Analytical, Medical Terminology, Statistical,
  • Advanced Training Specialty: Psychiatry
  • Ability to organize, prioritize tasks and work independently, as well as in a team.  Strong attention to details.


Please be advised: Effective Wednesday, September 1st, 2021, with the exception of those who receive an approved exemption, all new hires must provide proof of vaccination against COVID-19 or receive the first dose of a COVID-19 vaccine by the second Friday of employment.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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