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 Supervisor, Service Coordination Admin is responsible for supervising the Service Coordination Admin Team and assisting Service Coordination management. This position conducts daily reviews, provides leadership and guidance to staff to maintain a prioritized and productive workload. The Supervisor, Service Coordination Admin coordinate the training of new staff, and serve as a resource person for all staff.  The Supervisor, Service Coordination Admin 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 ensures that employees comply Medicare / Medicaid, TDI and all regulatory governing entities.

JOB SPECIFICATIONS

Sharing and supporting tasks and training with the Service Coordination Leadership team. Uses product acumen, knowledge of template creation to quickly and accurately resolve issues raised by team members and / or internal and external stakeholders and responsible for compliance process improvement.

Ensure accurate creation of authorizations for LTSS services, follow up on authorized services, member requests, and other services as directed by the Service Coordination staff. Ensures member visit scheduling is completed timely and accurately.

Responsible for monitoring daily reporting to refer to leadership for processing and creating authorizations for management decisions.

Responsible for providing oversight of staff productivity to meet department key metrics and productivity standards.  Conduct staff documentation audits and ensure tasks are completed within established threshold for timeliness and accuracy within compliance timeframes.

Actively contributes to achievement of departmental goals, as identified in Department¿s annual business plan, including specific departmental process improvement plans and other duties as assigned.

Other tasks as assigned by leadership.


QUALIFICATIONS:

Education/Specialized Training/Licensure: High School Diploma or GED required.

Associate's degree, bachelor's degree in healthcare administration, Public Health, or related field preferred.


Work Experience (Years and Area): 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 (Years and Area): 6 months or more of healthcare or health plan leadership experience required.

Software Proficiencies: Microsoft Office (Word, Excel, Outlook)

Other: Able to work independently under general 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!