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: 

Complex Case Manager Team Leader will manage CHC members with complex diseases, conditions or medically complicated needs through comprehensive evaluation and through coordination of resources.  The Complex Case Manager Team Leader will participate as a team member in CHC Complex Case Management program. Complex Case Managers will work collaboratively with utilization management, member services and the quality improvement departments.

MINIMUM QUALIFICATIONS:

• Education/Specialized Training/Licensure: RN current Texas License required; BNS preferred; CCM required or must receive within 18 months of employment.
• Work Experience (Years and Area): Six years clinical experience.  Minimum 1-year hospital experience and 2 years complex case management experience
• Software Operated: Microsoft Office (Word, Excel, Outlook)

SPECIAL REQUIREMENTS: 

• Communication Skills:
• Above Average Verbal (Heavy Public Contact)
• Writing /Composing     Correspondence   / Reports
• Analytical              
• Medical Terms
• MS Word  

Advanced Education:

• Advance Training Specialty: CCM required or must receive within 18 months of employment
• Bachelors Degree Major: BSN preferred
• Work Schedule:   Flexible

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!