Supplemental Utilization Management Coordinator - Community Health Choice
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: Primarily responsible for the initiation of cases by data entry of clinical, demographic and product information into the Medical Management system, via telephone, fax or online portal. Electronically routes cases to the nurse for review and decision. Handles data entry of all precertification of inpatient and outpatient service request. Responsible for accurate case completion /quality and productivity standards while staying within compliance timeframes. Handles provider outbound calls according to departmental standards. Provides a high level of customer service while communicating with internal departments and provider office staff as it pertains to performance of job responsibilities. Works independently with minimal supervision.
1. Education/Specialized Training/Licensure: High School Diploma required. Associate¿s degree preferred
2. Work Experience (Years and Area): 2 years¿ data entry experience in a healthcare setting such as medical clinic, hospital, or managed care. 1 year utilization management experience preferred.
3. Management Experience (Years and Area): N/A
4. Software Operated: Microsoft Office (Word, Excel, Outlook)
SPECIAL REQUIREMENTS: (Check Applicable Areas)
1. Communication Skills:
Writing /Composing: Correspondence / Reports
2. Other Skills: Analytical, Medical Terminology, MS Word, MS Excel
3. Advanced Education:
Advanced Training Specialty: Associate's degree preferred
4. Work Schedule: Flexible
5. Other Requirements:
Able to work independently under general instructions