Mgr Clinical Support

2 weeks ago

Bellaire, United States Texas Children's Hospital Full time
Job Description

We're hunting for a Manager of Clinical Support, someone who's ready to be part of the best ranked children's hospital in Texas, and among the best in the nation. In this position, you will be responsible for assisting with the interpretation of federal, state, and other regulations and requirements related to all Medicaid products, and coordinating/providing the necessary reporting requirements in a timely manner.
Responsibilities include direct and indirect supervision or clinical and non-clinical team members. Develops, tracks, and reports performance/productivity metrics, and assures direct reports are meeting established metrics. Frequently reviews processes, workflows, and policies/procedures to ensure they are accurate, current, and meet all regulatory requirements. Works collaboratively with leadership and others from various areas across the health plan to evaluate and implement new ideas and strategies that impact member care coordination and quality of life, while ensuring compliance with the above
regulations and requirements. Continue development of key strategic initiatives and reporting by partnering with the finance and operating teams to translate strategic analysis into operational decision-making. Manages call center staff to ensure quality calls and key performance metrics are met and adhered to according to any internal or external requirements. Manages member advocate team to ensure member complaints and appeals are handled timely and accurately.

Think you've got what it takes?

Job Duties & Responsibilities
•Develops strategies, policies, and procedures to ensure regulatory compliance.
•Reviews, interprets, and provides direction on new and changes to existing federal and state regulations and requirements mandated by Health and Human Services Commission (HHSC), Texas Medicaid & Healthcare Partnership (TMHP), Texas Department of Insurance (TDI), and other governing bodies. Remains current on Texas Medicaid Provider Procedures Manual (TMPPM), Uniform Managed Care Contract (UMCC), Uniform Managed Care Manual (UMCM), and other bodies of knowledge that impacts all Medicaid requirements and have a direct impact on medical policy decisions and potential system configuration changes.
•Ensures that policies/procedures, standard operating procedures, desk-level procedures, and/or guidelines adhere to all Medicaid regulatory requirements as they relate to benefits and reimbursement and staff are adequately trained in them.
•Partners closely with the Program Support Unit (PSU) within Health and Human Services Commission (HHSC) to understand and implement program and/or reporting changes.
•Develops methodology for analyzing and monitoring departmental operations, internal and State issued Corrective Actions Plans, and Liquidated Damages.
•Accountability B: Ensures appropriate communications and partners with others both within and across teams to accomplish goals.
•Provides data and reporting on productivity and other metrics.
•Develops and implements process improvement initiatives, both clinical and non-clinical.
•Ensures quality calls and key performance metrics are met and adhered to according to any internal or external requirements for the call center.
•Manage the Quality of the Care Coordination Team at the Health Plan using nursing/clinical Knowledge.

Skills & Requirements
•Required bachelor's degree Nursing
•Required RN - Lic-Registered Nurses by the Texas Board or Nursing or Nurse Licensure Compac
•Required 4 years Business Operations in a Healthcare or Insurance
•Environment, or Nursing Managed Care experience
•Preferred Management/Leadership experience

About Us

Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.

To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.

Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

  • Mgr, Financial IS

    4 weeks ago

    Bellaire, United States Harris Health Full time

    Job Summary: Leads and supports system-level activities of a large integrated delivery system. Work product directly impacts information delivered to the Harris Health's Board of Managers and Commissioners Court as well as state and national surveys. Manages complex projects and initiatives across the system, which significantly impact business results, and...

  • Mgr, Financial IS

    2 months ago

    Bellaire, United States Harris Health Full time

    Job Summary: Leads and supports system-level activities of a large integrated delivery system. Work product directly impacts information delivered to the Harris Health's Board of Managers and Commissioners Court as well as state and national surveys. Manages complex projects and initiatives across the system, which significantly impact business results, and...

  • Clinical Psychologist

    2 weeks ago

    Bellaire, Texas, United States US ARMY - 5th Medical Recruiting Battalion Full time

    As a Clinical Psychologist, youll provide crucial mental health services to Soldiers and their Families. Youll learn the psychological principles to diagnose, treat, and support patients while directing medical units and conducting vital, life-saving research alongside dedicated colleagues in the U.S. Army Medical Corps.

  • Clinical Psychologist

    2 weeks ago

    Bellaire, Texas, United States US ARMY - 5th Medical Recruiting Battalion Full time

    As a Clinical Psychologist, you'll provide crucial mental health services to Soldiers and their Families. You'll learn the psychological principles to diagnose, treat, and support patients while directing medical units and conducting vital, life-saving research alongside dedicated colleagues in the U.S. Army Medical Corps.

  • Epic Clinical Systems Analyst II

    2 weeks ago

    Bellaire, United States Harris Health Full time

    The Epic Clinical Systems Analyst II ensures that the operational interests of their respective functional areas are being fully represented in the day-to-day operations of the Information Systems Department. This role supports the Epic Clinical applications deployed within the Harris Health System.MINIMUM QUALIFICATIONS: Education/Specialized...

  • Clinical Research Site Manager/director

    2 weeks ago

    Bellaire, United States Evolution Research Group Full time

    **Title: Site Manager** **Location: Bellaire, TX** **About us**: The Site Manager is responsible for the daily administrative, recruiting, regulatory and financial business activities of the company. **Responsibilities**: - Coordinate the review of all new clinical research protocols as they relate to the clinical and business feasibility aspects of...

  • IT Tech Support Analyst I

    2 weeks ago

    Bellaire, United States Harris Health System Full time

    Harris Health System is the public healthcare safety-net provider established in 1966 to serve the residents of Harris County, Texas. As an essential healthcare system, Harris Health champions better health for the entire community, with a focus on low-income uninsured and underinsured patients, through acute and primary care, wellness, disease management...

  • Clinical Research Site Manager/Director

    2 months ago

    Bellaire, United States EVOLUTION RESEARCH GROUP Full time

    Job DetailsJob LocationLOC009 HDR First Surgical Hospital - Bellaire, TXSite Manager/DirectorTitle: Site Manager Location: Bellaire, TXAbout us:ERG is a leading U.S. based, privately held, independent clinical research site company, and provider of clinical development services with expertise in early and late-stage neuroscience drug development. With 20...

  • Clinical Research Site Manager/Director

    4 weeks ago

    Bellaire, United States EVOLUTION RESEARCH GROUP Full time

    Job DetailsJob LocationLOC009 HDR First Surgical Hospital - Bellaire, TXSite Manager/DirectorTitle: Site Manager Location: Bellaire, TXAbout us:ERG is a leading U.S. based, privately held, independent clinical research site company, and provider of clinical development services with expertise in early and late-stage neuroscience drug development. With 20...

  • Clinical Research Coordinator II

    2 weeks ago

    Bellaire, United States Evolution Research Group Full time

    Job DetailsJob Location LOC009 HDR First Surgical Hospital - Bellaire, TX Clinical Research CoordinatorTitle: Clinical Research Coordinator IILocation: Bellaire TXAbout us: ERG is a leading U.S. based, privately held, independent clinical research site company, and provider of clinical development services with expertise in early and late-stage neuroscience...

  • Mgr Care Coord/Disease Management

    2 weeks ago

    Bellaire, United States Texas Children's Hospital Full time

    Job DescriptionWe are searching for a Manager of Care Coordination/Disease Management focused on Women's Health for The Health Plan - someone who works well in a fast-paced setting. In this position, you will manage staff and provide case management services to Texas Children's Health Plan members and to continually develop the identification, outreach, and...

  • Mgr Care Coord/Disease Management

    1 week ago

    Bellaire, United States Texas Children's Hospital Full time

    Job Description We are searching for a Manager of Care Coordination/Disease Management focused on Women's Health for The Health Plan - someone who works well in a fast-paced setting. In this position, you will manage staff and provide case management services to Texas Children's Health Plan members and to continually develop the identification, outreach, and...

  • Epic Clinical Systems Analyst Ii

    4 days ago

    Bellaire, United States Harris Health System Full time

    Harris Health System is the public healthcare safety-net provider established in 1966 to serve the residents of Harris County, Texas. As an essential healthcare system, Harris Health champions better health for the entire community, with a focus on low-income uninsured and underinsured patients, through acute and primary care, wellness, disease management...

  • Epic Clinical Systems Analyst Ii

    2 weeks ago

    Bellaire, Texas, United States Harris Health System Full time

    Harris Health System is the public healthcare safety-net provider established in 1966 to serve the residents of Harris County, Texas. As an essential healthcare system, Harris Health champions better health for the entire community, with a focus on low-income uninsured and underinsured patients, through acute and primary care, wellness, disease management...

  • Director - System Clinical Pharmacy Services

    4 weeks ago

    Bellaire, United States Harris Health System Full time

    Harris Health System is the public healthcare safety-net provider established in 1966 to serve the residents of Harris County, Texas. As an essential healthcare system, Harris Health champions better health for the entire community, with a focus on low-income uninsured and underinsured patients, through acute and primary care, wellness, disease management...

  • Mgr Care Coord/Disease Mgmnt BH

    2 weeks ago

    Bellaire, United States Texas Children's Hospital Full time

    Job Description To manage Behavioral Health staff and provide Behavioral Health case management services to Texas Children's Health Plan members and to continually develop the identification, outreach, and delivery of social supports as needed to respond to the strategic goals of Texas Children's Health Plan as well as the needs of the members. About Us...

  • Clinical Neuropsychologist, TIRR Challenge Program

    3 weeks ago

    Bellaire, United States Memorial Hermann Health System Full time

    At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed...

  • Subspecialty Ophthalmic Clinic Scribe

    2 weeks ago

    Bellaire, United States Retina Consultants of Houston Full time

    Retina Consultants of Texas (RCTX) is seeking an individual with compassionate values to join our prestiges Uveitis team.  If you are passionate about patient care and have a drive to learn, this may be the team for you.  The Sub-Specialty Scribe will be responsible to providing accurate documentation and summarization of the ocular examination and...

  • Advanced Practice Provider

    4 weeks ago

    Bellaire, United States Houston Methodist Full time

    Overview At Houston Methodist, the Advanced Practice Provider - Primary Care position is responsible for maintaining and promoting the health of the patient requiring primary care, while practicing medicine under the supervision of a licensed physician. This position will provide diagnostic, therapeutic and preventative care to primary care patients. This...

  • Advanced Practice Provider

    4 weeks ago

    Bellaire, United States Houston Methodist Primary Care Group Full time

    At Houston Methodist, the Advanced Practice Provider - Primary Care position is responsible for maintaining and promoting the health of the patient requiring primary care, while practicing medicine under the supervision of a licensed physician. This position will provide diagnostic, therapeutic and preventative care to primary care patients. This position...