Job Abstract

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.

JOB SUMMARY:

The Director of Care Management and Population Health is responsible for measurement, analysis, coordination and implementation of initiatives and programs within Medical Affairs to achieve transformational improvements in clinical and Social Determinants of Health outcomes.  The Director is responsible for all Care Management and Population Health functions, the development/implementation of strategies, processes and coordination of resources to meet and ensure all strategic objectives are met, and redesigns programs aimed to improve overall health outcomes of health plan members. The Director ensures that all care management and population health processes seamlessly integrate with existing UM, Member Services, Quality Management and Provider Relations processes and are data driven and for development of metrics and measurement of program and member health outcomes for each of these areas and ensure programmatic compliance with all contractual requirements from HHSC, TDI, CMS, URAC and other regulatory bodies.  The Director is also responsible for coordination with Quality Management to ensure quality goals and improved outcomes are achieved.

MINIMUM QUALIFICATIONS:

• Education/Specialized Training/Licensure: BSN degree, with active Texas RN license required. MBA, MPH, MHA and MSN preferred. Certification in Care Management or Population Health required (or must receive within 18 months of employment)
• Work Experience (Years and Area): Three years or more experience in Care Management or Population Health in a Managed Care environment required.
• Management Experience (Years and Area): Five years of supervisory experience of professional staff required
• Software Operated: Microsoft Office (Word, Excel, Outlook and PowerPoint)

SPECIAL REQUIREMENTS: 

• Communication Skills: Above Average Verbal (Heavy Public Contact), Exceptional Verbal (e.g., Public Speaking), Writing /Composing  (Correspondence  / Reports)
• Other Skills:  Analytical, Medical Terminology, MS Word, MS Excel
• Advanced Education:
• Bachelors Degree in Nursing
• Masters degree in health related field, or MBA with bachelors degree in health related field preferred
• Work Schedule: Flexible

RESPONSIBLE TO: Director

EMPLOYEE SUPERVISED:

Technical/Professional (NE)
Professional (Exempt)
Supervisory

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