Performance Adherence Specialist

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.

The overall objective of the Performance Adherence Specialist is to monitor and report the program outcomes for the STAR, STAR+PLUS, Marketplace and DSNPs contracts. The Performance Adherence Specialist will be responsible to monitor and report the activities of Service Coordination, Case Management and Utilization Management programs, to ensure all operational activities to include quality metrics, contractual regulatory and operational reporting requirements are met for STAR, STAR+ Plus, DSNP and Marketplace.The Performance Adherence Specialist is responsible for auditing and monitoring the performance of staff to ensure the delivery of best practices, and to ensure state deliverables are timely. The Specialist will utilize training and auditing tools to monitor service coordination for all lines of business to ensure adherence to policy and procedures, regulatory requirements, and accreditation standards.

QUALIFICATIONS:
Education/Specialized Training/Licensure:

• High School diploma required.
• Associate degree or higher preferred.

Work Experience (Years and Area):

• 5 years health care setting, including managed care organization.
• Auditing/compliance experience preferred.

Software Proficiencies:

• PC – Microsoft Office (Word, Excel, Outlook)

Community employees’ 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.

Harris Health System's benefits program is designed to provide you with more flexibility and choices in meeting your specific needs. Harris Health System's benefits program allows you to protect your income in case of illness, death and disability, and to help you save for retirement.

It is the policy of Harris Health System to provide equal opportunity for all applicants for employment regardless of political affiliation, race, color, national origin, age, sex, religious creed or disability. Applicants may request any reasonable accommodation(s) to participate in the application process.

Job Type: Full-time

Pay: $50,000.00 - $75,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible schedule
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Parental leave
• Professional development assistance
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Work setting:

• Remote

Work Location: Remote