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Director Compliance STAR+PLUS/CHC

at Harris Health System

Posted: 3/29/2019
Job Status: Full Time
Job Reference #: 145531
Keywords:

Job Description

About Us

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.

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, STAR+PLUS is responsible for overseeing all ongoing activities related to the development, implementation, maintenance of, and adherence to Community Health Choice's (Community) policies and procedures covering STAR+PLUS, Medicare Advantage, Medicare-Medicaid Plan (MMP) and Dual Eligible Special Needs Plans (D-SNPs). Organizes, directs and ensures the compliance of STAR+PLUS, Medicare Advantage, MMP, and D-SNP and plan managed care programs with all applicable State and Federal Regulatory bodies.

QUALIFICATIONS:

  • BA/BS or five years equivalent experience
  • Previous experience in a managed care organization. Highly preferred experience in Medicare Advantage, STAR+PLUS, MMP and D-SNP
  • Two years management experience in a healthcare setting

OTHER SKILLS:

  • Above Average Verbal (Heavy Public Contact)
  • Writing /Composing/(Correspondence/Reports)
  • Knowledge of Medicare Advantage, MMP, D-SNP and STAR+PLUS
  • Strong communication skills
  • Ability to organize tasks and work independently.
  • Strong attention to detail and deadlines.



Benefits and EEOC

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.

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Application Instructions

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