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Overview
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 programs including Medicaid STAR, CHIP, Health Insurance Marketplace Plans, and Community Health Choice (HMO D-SNP). Community offers care management programs for asthma, diabetes, and high-risk pregnancy. It is accredited by URAC for health plan operations and is financially self-sufficient, with no financial support from Harris Health System or Harris County taxpayers. Improving Members\' experiences is at the heart of every Community position. We strive daily to ensure Members have access to high-quality health care they need and deserve. Job Summary
Perform duties related to the day-to-day operations of the Behavioral Health Team. Case Management works with high-risk Members to identify needs and goals to achieve empowerment and improved quality of life for behavioral and physical health issues. Assess Members\' current functional level and, in collaboration with the Member, develop and monitor the Case Management Care Plan, quality of care; assist with discharge planning, participate in special clinical projects, and communicate with departmental and plan administrative staff to facilitate daily operations of the Behavioral Health Case Management functions. Collaborate with medical and behavioral providers, often onsite at hospitals or in the community, to ensure optimal care for Members. Work telephonically with patients and their Legal Authorized Representatives identified as high risk, for both behavioral and physical health issues, and their providers to identify needs, set goals and implement action steps towards achieving goals. Understand and comply with NCQA/ URAC guidelines and HEDIS measures. Minimum Qualifications
Education/Specialized Training/Licensure: Master\'s Degree in Social Work or Counseling; Current unrestricted license in the state of Texas: LCSW, LMSW, LMFT or LPC Work Experience (Years and Area): 2 years experience in managed care or hospital setting and 2 years in behavioral health case management preferred Management Experience (Years and Area): N/A Equipment Operated: Advanced PC knowledge, MS Word, MS Excel, MS Outlook, and excellent telephone skills Special Requirements
Communication Skills: Above Average Verbal (Heavy Public Contact); Exceptional Verbal (e.g., Public Speaking); Writing /Composing Yes (Correspondence / Reports) Other Skills: Medical Terminology; Typing; PC; MS Word; MS Excel Advanced Education: Advanced Training Specialty: LMSW, LCSW, LPC; Master\'s Degree Major: Social Work or Counseling Work Schedule: Flexible Travel: Yes Other Requirements: Excellent organization, coordination, and multi-tasking skills and abilities. Ability to organize and prioritize tasks and work independently. Strong attention to detail and deadlines. Will travel locally to hospitals as requested by manager or medical director when high risk or high utilizing member is inpatient. Responsibilities/Reporting
Responsible to: Supervisor/Manager Employee supervised: None
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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 programs including Medicaid STAR, CHIP, Health Insurance Marketplace Plans, and Community Health Choice (HMO D-SNP). Community offers care management programs for asthma, diabetes, and high-risk pregnancy. It is accredited by URAC for health plan operations and is financially self-sufficient, with no financial support from Harris Health System or Harris County taxpayers. Improving Members\' experiences is at the heart of every Community position. We strive daily to ensure Members have access to high-quality health care they need and deserve. Job Summary
Perform duties related to the day-to-day operations of the Behavioral Health Team. Case Management works with high-risk Members to identify needs and goals to achieve empowerment and improved quality of life for behavioral and physical health issues. Assess Members\' current functional level and, in collaboration with the Member, develop and monitor the Case Management Care Plan, quality of care; assist with discharge planning, participate in special clinical projects, and communicate with departmental and plan administrative staff to facilitate daily operations of the Behavioral Health Case Management functions. Collaborate with medical and behavioral providers, often onsite at hospitals or in the community, to ensure optimal care for Members. Work telephonically with patients and their Legal Authorized Representatives identified as high risk, for both behavioral and physical health issues, and their providers to identify needs, set goals and implement action steps towards achieving goals. Understand and comply with NCQA/ URAC guidelines and HEDIS measures. Minimum Qualifications
Education/Specialized Training/Licensure: Master\'s Degree in Social Work or Counseling; Current unrestricted license in the state of Texas: LCSW, LMSW, LMFT or LPC Work Experience (Years and Area): 2 years experience in managed care or hospital setting and 2 years in behavioral health case management preferred Management Experience (Years and Area): N/A Equipment Operated: Advanced PC knowledge, MS Word, MS Excel, MS Outlook, and excellent telephone skills Special Requirements
Communication Skills: Above Average Verbal (Heavy Public Contact); Exceptional Verbal (e.g., Public Speaking); Writing /Composing Yes (Correspondence / Reports) Other Skills: Medical Terminology; Typing; PC; MS Word; MS Excel Advanced Education: Advanced Training Specialty: LMSW, LCSW, LPC; Master\'s Degree Major: Social Work or Counseling Work Schedule: Flexible Travel: Yes Other Requirements: Excellent organization, coordination, and multi-tasking skills and abilities. Ability to organize and prioritize tasks and work independently. Strong attention to detail and deadlines. Will travel locally to hospitals as requested by manager or medical director when high risk or high utilizing member is inpatient. Responsibilities/Reporting
Responsible to: Supervisor/Manager Employee supervised: None
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