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 Quality Improvement Coordinator will assist with all reporting required by regulatory bodies or vendors that involves Risk Adjustment, HEDIS and Quality Improvement, and any internal reports to demonstrate efficacy of the program and internal controls. The primary responsibility of this role is to support the centralized medical record collections for HEDIS, RADV, Risk Adjustment, and Quality Improvement as required by federal statute and ensure compliance. Additionally, this role supports the team with scheduling of meetings, documenting of outcomes, facilitates the development of articles for newsletters/other communications, and other special projects to support the HEDIS, Risk Adjustment and Quality Improvement team.

MINIMUM QUALIFICATIONS:

1. Education/Specialized Training/Licensure: Bachelor's degree preferred or equivalent work experience (Preferred, Healthcare, Business, Health or related discipline)

2. Work Experience (Years and Area): One (1) year healthcare experience with a degree; 3 or more years of experience without a degree

3. Management Experience (Years and Area): None required

4. Equipment Operated: Customary office equipment including PC, copier, fax, telecommunications equipment, etc. Knowledge of Microsoft
Word, Excel, PowerPoint and Outlook

SPECIAL REQUIREMENTS: (Check Applicable Areas)

1. Communication Skills:
Above Average Verbal (Heavy Public Contact)

Writing /Composing  (Correspondence)

2. Other Skills:
Analytical
Medical Terminology
MS Word

3. Advanced Education:

Bachelor's Degree Major: Healthcare preferred, but not required


4. Work Schedule: Flexible

5. Other Requirements: Ability to manage complex projects across multiple departments, critical thinking skills. Strong communication and organizational skills are required.



 

Application Instructions

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