Highlights
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. 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.
Numbers & Facts
| Location | Houston, TX |
| Industry | Healthcare Services |
| Company Size | 5,000 to 9,999 employees |
| Year Founded | 1966 |
| Website | https://www.harrishealth.org/en/pages/home.aspx |
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.
JOB SUMMARY
The Behavioral Health Case Management Team Lead will manage CHC members with behavioral health diagnosis through comprehensive evaluation and through coordination of resources. The Behavioral Health Case Management Team Lead will participate as a team member in CHC Behavioral Health Department.
The Behavioral Health Case Management Team Lead will work collaboratively with utilization management, member services and the quality improvement departments.
JOB SPECIFICATIONS AND CORE COMPETENCIES
Coordinates daily operational aspects of team and assists manager with staff
supervision:
Monitors and facilitates equal distribution of workload assignments
Assists manager in setting productivity goals
Monitors Coordinators and Behavioral Health Case Managers to ensure performance and productivity metrics are met
Reviews and documents staff productivity on monthly and ad hoc basis
Informs manager about escalated issues and works with manager to resolve them
Monitors adherence to attendance, PTO, lunch, and break guidelines
Quality/Process Improvement:
Complete quality audits by comparing productivity sheets to recorded calls and documentation in the system
Provides information for employee performance reviews.
Identifies training needs
Ensures that staff completes required training
Holds monthly team meetings with staff and documents minutes
Evaluations of team members and any necessary improvement plans
Completes documentation and call monitoring audits quarterly and ad hoc
Assists with new and ongoing employee training and development of training documents
Identifies opportunities for process and productivity improvement and shares with manager
Assist with the development of policy and procedures and job aides pertaining to the Behavioral Health Case Management Team
Coaches and mentors staff on issues identified
Assist with Program Management:
Development and/or redesign of the Behavioral Case Management Program
Recommend improvements to the Behavioral Health Case Management Program
Development or redesign of program materials
Maintain and report required Program Analytic requirements.
Complete special projects as assigned
Actively contributes to achievement of departmental goals, as identified in Departments annual business plan, including specific departmental process improvement plans
Other duties as assigned.
QUALIFICATIONS:
Education/Specialized Training/Licensure: Master's Degree in Social Work, Counseling required.
LMSW, LCSW, LPC, LMFT required.
CCM, ACM preferred.
Work Experience (Years and Area): Minimum of 4-years BH Case Management to include Minimum of 1 Year MCO experience
Software Proficiencies: Microsoft Office (Word, Outlook, Excel)
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About Company
Harris Health is a nationally recognized health system comprising three teaching hospitals and an extensive network of ambulatory care centers serving the people of Harris County, Texas, since 1966. Staffed by the faculty, fellows and residents from two nationally ranked medical schools, Baylor College of Medicine and The University of Texas Health Science Center at Houston (UTHealth), Harris Health is the first healthcare system in Houston to receive the prestigious National Committee for Quality Assurance (NCQA) designation for its network of patient-centered medical homes.
Each year, Harris Health provides more than 1.8 million total outpatient visits through its more than 40 ambulatory care facilities. Additionally, Harris Health sees more than 177,000 emergency visits at its Level 1 and Level 3 trauma centers and 35,000 hospital admissions through its three hospitals: Ben Taub, LBJ and Quentin Mease. Established by voter referendum to enhance the level of charity care available in the community, Harris Health System has often received national recognition for serving those in need and for its achievements in operational excellence, such as being named to the 2011, 2012, 2013 and 2014 Most Wired Hospitals lists by the American Hospital Association's Hospitals & Health Networks magazine.
Additionally, Harris Health System is pleased that each of its three hospitals: Ben Taub, Lyndon B. Johnson and Quentin Mease - achieved Pathway to Excellence designation by the American Nurses Credentialing Center.