Community Health Choice

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Job Details

Utilization Management/RN/Supplemental

at Community Health Choice

Posted: 3/19/2020
Job Status: Part Time
Job Reference #: 149522
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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

CONTRACT POSITION - SIX MONTHS

Community Health Choice is seeking UM/RN’s to work for a six month project who will perform utilization review of Community members requiring authorization for health services and will ensure proper data entry of authorization in the managed care platform.¿ The UM/RN will initiate the approval process for requested services/treatments utilizing nationally recognized evidenced based clinical criteria and/or internal policy’s, protocols, and procedures. The UM RN will screen and review clinical information for the most appropriate service areas within Community; making referrals to high risk perinatal team, complex case management and disease management. The UM RN will work closely with the Medical Directors and refer requests that do not meet medical necessity criteria. The UM RN has heavy telephonic and facsimile contact with providers and their representatives. ¿Hourly pay: $50.00

Requirements:

  • Associate’s Degree, BSN licensed in Texas

  • Three years in an acute care setting

  • One year of utilization experience in a managed care environment

¿

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.

Job Category

Community Health Choice (CHC)

Application Instructions

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