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 Vice President, Medical Affairs Operations provides focused executive leadership to Community's Utilization Management and Care/Disease Management programs for Medical and Behavioral Health Services. This position ensures the efficient operation of these programs, including pre-authorizations of medical services, concurrent review of hospital admissions, and coordination on peer related interactions to support the UM activities. The VP-Medical Affairs Operations leads the ongoing development and facilitation of Care/Disease Management programs appropriate to Community's covered populations. Additionally, this position plays a key role on Community's Executive Leadership team participating in organization-wide strategy development and decision making.
 

QUALIFICATIONS:   

  • Licensed Registered Nurse required. Bachelors' degree required preferably in a related field such as Nursing (BSN), Business Administration or Healthcare Administration. A Master's degree in one of these disciplines preferred. 
  • Ten years clinical experience with seven years in leadership to include five years' in leadership specifically in managed care.

OTHER SKILLS:

  • Writing /Composing/Correspondence /Reports
  • Analytical, Statistical
  • Proven leadership abilities.
  • Collaboration/Team focused
  • Effective communicator with solid presentation skills.
     

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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