Care Management Nurse RN

Job Description

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.

Skills / Requirements

JOB SUMMARY:

Care Manager will manage Community Health Choice (Community) members with chronic disease and medically complicated needs through comprehensive evaluation and through coordination of Community resources. The Care Manager will participate as a team member in Community Care Management programs, which are designed to assist members with chronic diseases in self-management skills. Care Manager will work collaboratively with utilization review, member services and the quality improvement department.

Minimum Qualifications

• Education/Specialized Training/Licensure: RN, current Texas License CCM required or must receive within 18 months of employment.
• Work Experience (Years and Area):Three years of clinical experience
• Software Operated: Microsoft Office (Word, Excel, Outlook).
  
  

Special Requirements

• Communication Skills: Above Average Verbal (Heavy Public Contact)
• Writing /Composing: Correspondence / Reports
• Other Skills: Analytical, Medical Terminology, Research, MS Word, MS Excel
• Advanced Education:Advanced Training Specialty: CCM Preferred
• Work Schedule: Flexible
  
  

RESPONSIBLE TO: Supervisor/Manager