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
The Sr. Manager of NCQA Health Plan Accreditation plays a key role in Community Health Choice. Individual & Family Plan (IFP) clinical organization. This leader is accountable for overseeing and actively supporting the development, implementation, and management of NCQA health plan accreditation. They are responsible for annual and as-needed review of accreditation-related policies and procedures. This individual will be relied upon for presentations of accreditation materials to applicable committees. The Sr. Manager of NCQA Accreditation will identify areas of opportunity and collaborate with leadership to remediate risk.
QUALIFICATIONS:
- Bachelor’s Degree in clinical or health care field required.
- Master’s degree in a health care related field or business strongly preferred.
- Five years progressively responsible management experience in a health care environment.
- Three years experience in a lead position with NCQA accreditation required.
- Five years of with NCQA accreditation preferred.
OTHER SKILLS:
- Demonstrated leadership experience specific to a Health Plan Accreditation process.
- Excellent communication skills.
- Ability to facilitate projects across organization and ensure timely delivery of required documents.
- Proficient in annotating and uploading documents to the NCQA portal required.
Application 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!
Note: Current Community Health Choice employees must log in to PeopleSoft via CITRIX to explore career opportunities as an internal candidate. Click HERE for instructions.