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 Senior Director of LTSS will oversee the implementation and ongoing execution of the strategic and operational business plans for Community Health Choice. This position will be responsible for Service Coordination, Case Management, and UM review for PA and long-term services and supports. The Senior Director will build relationships across all business lines to ensure cohesiveness, and all contractual obligations are met. Oversight of staffing models/resource and budget management, policies and procedures, and reporting. The Senior Director will collaborate across multiple business lines to ensure Community Health Choice objectives are aligned, business strategies are developed and delivered timely, and financial, compliance and quality objectives are met.
Hire, develop, and motivate a high performing team to meet organizational goals and objectives while effectively managing change. Ensure that processes are aligned with NCQA, HHSC and all governing bodies. Oversee and ensure compliance with all applicable Federal and State regulations relevant to the plan's function. Develop and maintain internal departmental auditing tools and processes for proactive monitoring for all relevant quality and compliance performance metrics. Partner effectively with the STAR/CHIP Program operations to meet all LTSS requirements.


Essential Functions
This position shall ensure that LTSS staff are trained, knowledgeable and adhere to the requirements of the state of Texas, to include HCBS Waivers, guidelines, rules and requirements, CFC (Community First Choice), Money Follows the Person Program, and Nursing Facility standards.

Promote a clear vision aligned with company values and direction' set SMART goals and achievable objective. Motivate and empower staff to balance member needs while being a good steward of the financial budget. Challenging and motivating the team to create quality products, services, and solutions.

Implements and monitors the business plan and oversees any implementations or business transitions impacting service operations. Develop and manage clinical operations focused on improving clinical and financial outcomes, member engagement, and satisfaction.

Develop and implement staffing models that are consistent, cost effective, and compliant with contractual obligations. Lead recruitment and operating model development to meet operational growth needs. Foster an environment that supports professional development, mobility, and operational excellence.

Develop, implement, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Community Health Choice strategies, policies, and programs.

Develop, implement, and evaluate policies and procedures, which meet business needs (may cross multiple business functions). Direct enhancements to business processes, policies, and infrastructure to improve operational efficiencies.

Ability to develop business cases for new staffing investments and work with finance to secure funding when additional staff are warranted.

Ability to develop, evaluate and articulate current status, planning, and strategic initiatives via executive level presentations and able to speak professionally to Executive Level audience.

Ability to successfully motivate, drive and lead colleagues in Manager, Supervisory and field level positions.

Ability to interpret State contract to ensure Community Health Choice is performing to contract expectations.

Skilled in managing people, conflict resolution, ability to influence success at all levels including non-clinical staff.

Collaborate and partner with HHSC and all regulatory agencies to ensure CHC is meeting all obligations and reports are submitted timely.

Partner with Quality and Compliance to ensure URAQ and NCQA standards are met.

Develop and participate in presentations to governing entities. Participate in internal and external health industry development efforts.

Marginal Functions

Prepare concise ad clear documents and presentation for Executive Leadership

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.


Education/Specialized Training/Licensure:
Licensed RN in the state of TX or compact license required.


Master's Degree preferred.

Work Experience (Years and Area):
3 -5 years of experience working in Medicaid Long Term Services & Supports (LTSS), and/or experience with care management.

Experience with Waiver and HBCS programs.

Experience with data-driven program management.

Experience working with a government program.

Management Experience (Years and Area):
5-7 years of experience in a Senior Manager, or Director role managing large teams of 75+ employees

Software Proficiencies:
Personal Computer, Microsoft Office, Clinical Documentation Platforms

Altruista, Tableau, Power BI, ServiceNow, QNXT,

Application Instructions

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