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.
JOB SUMMARY
The Director, Behavioral Health is accountable for the operational management of the Behavioral Health Team. Responsible for human resources, quality, and financial management of the program. The Director oversees implementation of case management and utilization functions, while serving as a clinical leader and resource for Behavioral Health. As a Director, Behavioral Health you will implement policies and procedures, while adhering to regulatory and non-regulatory standards. The role is responsible for evaluations and reports relevant to achievement of goals for the Utilization Management and Case Management teams. Provides oversight to ensure area staff utilization and engagement patterns are congruent to standards.
JOB SPECIFICATIONS AND CORE COMPETENCIES
Department Management
Implement, monitor, and facilitate attainment of performance metrics to meet departmental expectations for productivity and quality. Manage the staffing needs by reviewing analytic reports for productivity, pended cases, average admissions per facility, and complexity if facility needs.
Conducts monthly audits of UM/CM teams and coordinators. Audits may be performed more frequently based on results or staff performance indicators Coordinates clinical rounds and coaches UM/CM's in preparing summaries and presenting cases.
Works independently and takes initiative to improve UM/CM processes. Participates in work groups and committees, while overseeing clinical presentations to medical directors.
Responsible for daily operations and ensuring staff assignments support workload. Ensures that staff onboarding and orientation is completed for all staff. Facilitate clinical rounds and recommends training. Oversee staff in the discharge planning needs of hospitalized members.
Cross-functional Duties
Participates in Medical Affairs department programs, focus studies and all initiatives to improve the health and quality of clinical care and service delivery to the Community members and providers. Ensures turnaround time compliance is met with all UM / CM processes. Works with staff to mitigate and prevent non- compliance. Coordinates and monitors staff referrals to medical case management, high risk perinatal, and disease management and quality improvement teams when appropriate.
Actively contributes to achievement of departmental goals, as identified in Department's annual business plan, including, specific departmental process improvement plans, and other duties as assigned.
Reports to Position Title: SVP Medical Affairs
Employees Supervised Titles: Behavioral Health Staff
QUALIFICATIONS:
Education/Specialized Training/Licensure:
' Master's degree in social work or counseling required.
' Current unrestricted license in the state of Texas: LCSW, LMSW, LMFT or LPC required.
' 10 years' experience in case management and utilization management combined required.
Management Experience (Years and Area):
' 7 years' experience managing cross-functional teams in a managed care environment required.
Software Proficiencies:
' Advanced PC Skills, MS Word, MS Excel, MS Outlook
