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
The Service Coordination Admin is responsible for assisting the Service Coordination staff with the submission and tracking of assessments, communications, and documents relating to the STAR+PLUS program. The Service Coordination Admin will also coordinate with members and medical providers to obtain needed referrals, physician signature and other supporting documentation needed for identified member needs/requests.  The Service Coordination Admin will also assist the Service Coordination staff to track the due dates for required assessments and contacts.  The Service Coordination Admin will also assist with Service Coordination staff with creation of authorizations for LTSS services, and following up with members to ensure the initiation and satisfaction with authorized LTSS services.  The Service Coordination Admin will also assist the Service Coordination staff with scheduling of face-to-face visits as directed by the Service Coordination staff. 

JOB SPECIFICATIONS AND CORE COMPETENCIES

Monitor and track assessment due dates to ensure timely completion of assessments by Service Coordination staff.  Coordinate with members and physicians to obtain needed signatures and documentation required for identified or requested needs as directed by the Service Coordination staff.  Create and send authorizations for LTSS services as directed by Service Coordination staff.

Assist the Service Coordination staff by scheduling face-to-face visits as directed by the Service Coordination staff.

Perform follow up calls to members to ensure timely delivery and initiation of authorized LTSS services.  Report any delays or dissatisfaction in services to the assigned Service Coordinator.

Participate in Team meetings, case conferences, and other calls or meetings as required.

Actively contributes to achievement of departmental goals, as identified in Department's annual business plan, including specific departmental process improvement plans and other duties as assigned.

All other tasks as assigned.

QUALIFICATIONS:
Education/Specialized Training/Licensure: High School Diploma or GED required.

Associate degree, Bachelor¿s Degree in Healthcare Administration, Public Health, or related field preferred.

Work Experience (Years and Area): 1 years of experience in a healthcare/managed care setting. Experience working with applicable state, federal, and third-party regulations required.

Medicare/Medicaid population experience preferred.

Management Experience (Years and Area): N/A

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

Other:  Able to work independently under general instructions.

Application Instructions

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