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 Utilization Management (UM) Supervisor is responsible for supervising the UM Coordinator Intake Team and assisting UM management. This position conducts daily reviews, provides leadership and guidance to staff to maintain a prioritized and productive workload. The UM Supervisor performs reviews and audits to assure quality, accuracy, and timeliness standards are being met and ability to provide guidance on how to accomplish standards and also ensures that employees are in compliance Medicare / Medicaid, TDI and all regulatory governing entities.
- Education/Specialized Training/Licensure: High School Diploma required: Associates Degree, Bachelors Degree in Healthcare Administration, Public Health, or related field preferred.
- Work Experience : 2 years of experience in a healthcare/managed care setting. Experience working with applicable state, federal, and third party regulations required. Medicare/Medicaid population experience required.
- Management Experience: 6 months or more of healthcare or health plan leadership experience required.
- Software Operated: Microsoft Office (Word, Excel, Outlook)
- Other Requirements: Able to work independently under general instructions
- Must be flexible to work alternative hours including the weekend and on call as needed
- Communication Skills:
- Above Average Verbal (Heavy Public Contact)
- Writing /Composing: Correspondence / Reports
- Other Skills: Analytical, Medical Terminology, Research, Statistical,
- MS Word, MS Excel
- Advanced Education:Bachelors Degree Major: Bachelors Degree in Healthcare Administration, Public Health, or related field preferred.
- Work Schedule: Flexible
- RESPONSIBLE TO: Supervisor/Manager
- EMPLOYEE SUPERVISED: Staff