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
- Childrenâs 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.
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
The Director Compliance State Programs provides direct support to the Chief Compliance Officer (CCO), focusing on the ongoing evaluation of adherence to regulatory control processes across all state product lines (STAR, CHIP, STAR+PLUS) and functions within the organization. Drafts policies and procedures and leads risk assessment, testing and compliance initiatives.
QUALIFICATIONS:
- Bachelors degree
- Five years in an advanced role within a Medicare/Medicaid Managed Care Organization; at least four years of experience conducting client facing activities; at least four years in a compliance related role.
- Five years of management or supervisory experience
OTHER SKILLS:
- Demonstrated project management and strategic planning skills; Knowledge of government programs, regulations, and compliance requirements;
- Customer service skills with the ability to interact professionally and effectively with providers, third party payers, physicians, and staff
- Organizational skills with the ability to handle multiple tasks and/or projects at one time.
- Decision making skills with the ability to investigate and weigh alternatives and select the course of action that provides the greatest benefit to the organization.
- Creative thinking skills with the ability to ask the needed bigger picture questions that lead to process and team improvements.
- Problem solving skills with the ability to look for root causes and implementable, workable solutions.
- Establishes effective relationships, exhibits tact and consideration, and displays a positive outlook
- Time management, attention to detail and ability to monitor progress against deadlines is critical.
- Demonstrates the ability to perform well and maintain composure under stress.
- Demonstrates effective oral and written communication skills.
Benefits and EEOC
Community employeesâ 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
CHC Professional
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