Director, Care Management
Houston, Texas
Employer: Harris Health System
Industry: Care Management
Salary: Competitive
Job type: Full-Time
About Us
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.
Internal Applicant
No job description available
Job Profile
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 :
SPECIAL REQUIREMENTS: (Check Applicable Areas)
Work Schedule: Flexible
Benefits and EEOC
Community employees’ benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and choices in meeting your specific needs.
Community is an Equal Opportunity Employer.
Job Category
Community Health Choice (CHC)
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.
Internal Applicant
No job description available
Job Profile
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: (Check Applicable Areas)
- 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:
Work Schedule: Flexible
Benefits and EEOC
Community employees’ benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and choices in meeting your specific needs.
Community is an Equal Opportunity Employer.
Job Category
Community Health Choice (CHC)
Created: 2024-08-27
Reference: 172184
Country: United States
State: Texas
City: Houston
ZIP: 77069
Similar jobs:
-
Submission for the position: Care Manager RN - (Job Number: 24012736)
Baylor Scott & White Healthcare in Fort Worth, Texas -
Care Manager Assistant
Right At Home in Athens, Texas -
Care Management Nurse RN
Harris Health System in Houston, Texas -
RN Care Transition Manager / Case Manager PRN
Texas Health Resources in Azle, Texas -
Submission for the position: Care Manager RN - (Job Number: 24014506)
Baylor Scott & White Healthcare in Rowlett, Texas -
Care Manager Assistant
Right At Home in Sulphur Springs, Texas -
Behavioral Health Interdisciplinary Program (BHIP) RN Care Manager
Veterans Health Administration in Corpus Christi, Texas -
Key Account Manager - Surgery and Critical Care - West TX/NM
Taylor Strategy Partners in Fort Worth, Texas -
Care Manager Assistant
Right At Home in Longview, Texas -
Care Coach Connect RN Case Manager - Lubbock, TX
UnitedHealth Group in Lubbock, Texas -
Inpatient Care Management Nurse TX Market - Remote
UnitedHealth Group in Dallas, Texas💸 $58300 - $114300 per year -
BOM- Business Office Manager (Long Term Care Facility)
Frontier Management in Plainview, Texas -
Submission for the position: Care Manager RN - (Job Number: 24014457)
Baylor Scott & White Healthcare in Dallas, Texas -
RN Care Transition Manager / Emergency Department
Texas Health Resources in Bedford, Texas -
Manager, Animal Care
Baylor College of Medicine in Houston, Texas💸 $67704 - $80000 per year -
RN Care Transition Manager PRN
Texas Health Resources in Fort Worth, Texas -
Care Manager II
Compunnel in San Antonio, Texas -
Care Manager Assistant
Right At Home in Nacogdoches, Texas -
Nurse Manager of Progressive Care
Methodist Healthcare in San Antonio, Texas -
Director Care Management
CHI in Lufkin, Texas