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.

Job Profile

Used Exclusively for Recruiting Job Openings

Job Profile

JOB SUMMARY

Community Health Choice (CHC) works with High-Risk members, providers, and multidisciplinary team members to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. CHC TOC staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

JOB SPECIFICATIONS AND CORE COMPETENCIES

• Field Travel to local hospitals, homes, and clinics. Minimum of 35 Field visits a month. Conducts face to face visits of all members while in the hospital and home visits of high-risk members post discharge.
• Follows member throughout a 30-day program that starts at hospital admission and continues through transitions from the acute setting to other settings, including nursing facility placement and private home, with the goal of reduced readmissions.
• Ensures safe and appropriate transitions by collaborating with hospital discharge planners, as well as with hospitalists, outpatient providers, facility staff, and family/support network, as needed or at the request of member.
• Works with participating ancillary providers, public agencies, or other service providers to make sure necessary services and equipment are in place for a safe transition.
• Coordinates care and reassesses member's needs using the Coleman Care Transitions Model recommended post-discharge timeline. Assesses for barriers to care, provides care coordination and assistance to member to address concerns.
• Educates and supports member focusing on seven primary areas (TOC Pillars): medication management, use of personal health record, follow up care, signs and symptoms of worsening condition, nutrition, functional needs and or Home and Community-based Services, and advance directives.
• 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.

MINIMUM QUALIFICATIONS:

• Education/Specialized Training/Licensure: Graduate from an Accredited School of Nursing required.
• Bachelors degree in nursing preferred.
• Active, unrestricted Transitions of Care Sub-Specialty Certification and/or Certified Case Manager (CCM) preferred.
• Work Experience (Years and Area): 1-3 years hospital discharge planning or home health. 3-5 years hospital discharge planning or home health.
• Software Proficiencies: Computer literate with knowledge of MS Word, MS Excel, Outlook, and telephone systems
• Other: Active, unrestricted State Registered Nursing (RN) license in good standing.
• Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

Benefits and EEOC

Harris Health System's benefits program is designed to provide you with more flexibility and choices in meeting your specific needs. Harris Health System's benefits program allows you to protect your income in case of illness, death and disability, and to help you save for retirement.

It is the policy of Harris Health System to provide equal opportunity for all applicants for employment regardless of political affiliation, race, color, national origin, age, sex, religious creed or disability. Applicants may request any reasonable accommodation(s) to participate in the application process.

Job Category

Nursing