Manager, Care Management

2 months ago

Houston, United States Harris Health System Full time

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**:
**JOB SUMMARY**

The Manager will supervise all Care Management (CM) functions for CHC and CHC members in the CM programs. The Manager will supervise CM staff in the enrollment and ongoing outreach to CHC members and care-coordination to members in the CM programs. The Manager will review all programs at least annually and work with Medical Affairs staff and senior leadership to update program goals and content. In addition, the Manager will identify other conditions for which CHC should prepare a care management program. The Manager will work with Analytics and Medical Affairs staff/management team to ensure that 1) members are being contacted and enrolled appropriately; program results, including ROI when measurable, are reported on a quarterly basis; program problems are identified; and 4) process improvements are recommended and implemented.

**JOB SPECIFICATIONS AND CORE COMPETENCIES**
- Oversees daily management of Care Management staff, including timecards,
- counseling, coverage, etc. Ensures that the regulatory turnaround times and deadlines are met.
- Ensures that monthly reports are reviewed with Director of Quality & Outcomes and Medical Affairs management team as needed monthly and implements appropriate corrective actions. Updates CM sections of the Key Management Report (KMR).
- Develop action plans to measure results and possible ROI for every program.
- Develop new and update existing policies, procedures and job aids that relate to Care Management programs as needed to ensure compliance with HHSC, TDI,
- UMCC, NCQA and URAC standards.
- Actively contributes to achievement of departmental goals, as identified in Department¿s annual business plan, including specific departmental process improvement plans. Other duties as assigned.

**QUALIFICATIONS**:

- Education/Specialized Training/Licensure: Active Texas RN license required.
- BSN preferred. Certification in Clinical Case Management (CCM) preferred.
- Work Experience (Years and Area): 5 years experience in Care Management (Disease Management) or Care Management in an acute care setting or MCO. Other healthcare experience will be considered in lieu of CM experience.
- Management Experience (Years and Area): 3 years experience in management / leadership role.
- Software Proficiencies: Microsoft Office (Word, Excel, Access, Outlook)

  • Nurse Manager Critical Care

    4 days ago

    Houston, United States Clinical Management Consultants Full time

    Join an award-winning acute care hospital located in Metropolitan Texas! The Nurse Manager Critical Care will work at a 412-bed facility that delivers high-quality care with the most up-to-date and innovative medical technology. This well-known hospital is dedicated to providing safe and effective patient-centered and individualized care. Some of the...

  • Manager Care Management

    3 weeks ago

    Houston, United States Catholic Health Initiatives Full time

    **Overview** Baylor St. Luke's Medical Center is an internationally recognized leader in research and clinical excellence that has given rise to breakthroughs in cardiovascular care neuroscience oncology transplantation and more. Our team's efforts have led to the creation of many research programs and initiatives to develop advanced treatments found...

  • Manager Care Management

    4 days ago

    Houston, United States Unavailable Full time

    Overview Baylor St. Luke’s Medical Center is an internationally recognized leader in research and clinical excellence that has given rise to breakthroughs in cardiovascular care neuroscience oncology transplantation and more. Our team’s efforts have led to the creation of many research programs and initiatives to develop advanced treatments found nowhere...

  • Manager Care Management

    4 weeks ago

    Houston, United States Common Spirit Full time

    Overview Baylor St. Luke's Medical Center is an internationally recognized leader in research and clinical excellence that has given rise to breakthroughs in cardiovascular care neuroscience oncology transplantation and more. Our team's efforts have led to the creation of many research programs and initiatives to develop advanced treatments found nowhere...

  • Manager Care Management

    5 days ago

    Houston, United States Catholic Health Initiatives Full time

    **Overview** Baylor St. Lukes Medical Center is an internationally recognized leader in research and clinical excellence that has given rise to breakthroughs in cardiovascular care neuroscience oncology transplantation and more. Our teams efforts have led to the creation of many research programs and initiatives to develop advanced treatments found nowhere...

  • Manager Care Management

    2 weeks ago

    Houston, United States Chi Full time

    Overview Baylor St. Luke's Medical Center is an internationally recognized leader in research and clinical excellence that has given rise to breakthroughs in cardiovascular care neuroscience oncology transplantation and more. Our team's efforts have led to the creation of many research programs and initiatives to develop advanced treatments found nowhere...

  • Manager Care Management

    4 weeks ago

    Houston, United States Catholic Health Initiatives Full time

    **Overview**Baylor St. Luke’s Medical Center is an internationally recognized leader in research and clinical excellence that has given rise to breakthroughs in cardiovascular care neuroscience oncology transplantation and more. Our team’s efforts have led to the creation of many research programs and initiatives to develop advanced treatments found...

  • RN Care Manager

    5 days ago

    Houston, United States Brookdale Senior Living Full time

    RN Care ManagerRN Care Manager Overview This position will support our Western/Central Houston communities. Daily travel to these communities will be required. Description for HeatlhPlus in the requisitions. Brookdale Senior Living Resident Care Manager A very unique opportunity to enhance healthcare delivery in our assisted living and memory care...

  • RN Care Management

    1 week ago

    Houston, TX, United States US Renal Care Full time

    RN, Market Management, Value-Based Care - Houston The Value-Based Care Management Registered Nurse interacts in-person and telephonically with chronic kidney disease patients, families, and support networks to provide comprehensive assistance in all areas related to ongoing education, medical history, medications, development of support systems, lifestyle...

  • Restaurant Manager

    2 weeks ago

    Houston, United States Thind Management Full time

    Job DescriptionJob DescriptionAre you passionate about delivering exceptional dining experiences? Do you have a knack for leading teams and ensuring operational excellence? If so, we have an exciting opportunity for you!About Us: We are a new fast casual dining restaurant located in the vibrant city of Houston, Texas. Our concept focuses on delivering...

  • Sales Manager

    4 days ago

    Houston, United States Raymond Management Full time

    ** Sales Manager** **Job Category****:** Sales **Requisition Number****:** SALES002741 Showing 1 location **Job Details** **Description** We are seeking a motivated individual with a passion for working with others and driving profitability. As a Sales Manager, you have the opportunity to build and maintain relationships with customers. You will play a key...

  • Assistant Manager

    4 days ago

    Houston, United States Fine Management LLC Full time

    Job DescriptionJob DescriptionDescription: The Assistant Manager is responsible for managing the day-to-day operations of our Houston facility serving Bush Intercontinental Airport (IAH). Core responsibilities include performance management and guest satisfaction while ensuring that the facility meets financial and operating goals.The Assistant Manager will...

  • Operations Manager

    3 days ago

    Houston, United States Fine Management LLC Full time

    Job DescriptionJob DescriptionDescription:The Operations Manager is actively involved in the day-to-day operations of our Houston facility serving Bush Intercontinental Airport (IAH). Core responsibilities include supporting the front-line team in day-to-day operations, performance management, and guest satisfaction while ensuring the facility meets...

  • Starbucks Manager

    2 days ago

    Houston, United States OTG Management Full time

    YOUR NEXT OPPORTUNITY IS NOW BOARDING Join OTG as a Starbucks® Manager now at IAH Airport and drive a new type of travel hospitality experience. Discover career opportunities in a unique hospitality environment with some of the industry's best compensation and benefits, including PTO, Healthcare, and a competitive 401k...

  • RN, Market Management, Value-Based Care

    2 weeks ago

    Houston, United States U.S. Renal Care Full time

    The Value-Based Care Management Registered Nurse interacts in-person and telephonically with chronic kidney disease patients, families, and support networks to provide comprehensive assistance in all areas related to ongoing education, medical history, medications, development of support systems, lifestyle changes and behavior modifications, thereby reducing...

  • RN Care Manager

    5 days ago

    Houston, TX, United States Brookdale Senior Living Full time

    RN Care Manager RN Care Manager This position will support our Western/Central Houston communities. Daily travel to these communities will be required. Brookdale Senior Living Resident Care Manager A very unique opportunity to enhance healthcare delivery in our assisted living and memory care communities! Brookdale HealthPlus is a unique service offered...

  • RN Care Manager

    5 days ago

    Houston, TX, United States Brookdale Senior Living Full time

    RN Care Manager RN Care Manager Overview This position will support our Western/Central Houston communities. Daily travel to these communities will be required. Description for HeatlhPlus in the requisitions. Brookdale Senior Living Resident Care Manager A very unique opportunity to enhance healthcare delivery in our assisted living and memory care...

  • Property Manager

    5 days ago

    Houston, United States Avan Property Management Full time

    AVAN Property Management is looking for A class luxury Property manager to lease up and manage the property. Avan has over 25 years of Property management experience and is growing. - **Must have A class property management experience**: - **Must have at least 5 years of experience as a Property Manager.**: - **Must have experience in managing at least 300...

  • General Manager

    5 days ago

    Houston, United States Dalwadi Hospitality Management Full time

    **Dalwadi Hospitality Management - Immediate General Manager Needed** Are you a highly skilled and motivated individual seeking a dynamic role in hotel management? Do you thrive in a fast-paced environment where leadership and teamwork are valued? If yes, then we have the perfect opportunity for you at Dalwadi Hospitality Management in Houston, Texas! The...

  • Director, Care Management

    3 days ago

    Houston, United States VillageMD Full time

    **Join VillageMD as a Director, Care Management in Houston, TX** **Join the frontlines of today's healthcare transformation** **Why VillageMD?** At VillageMD, we're looking for a **Director, Care Management** to help us transform the way primary care is delivered and how patients are served. As a national leader on the forefront of healthcare, we've...