Community Health Choice

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Medical Affairs Trainer

at Community Health Choice

Posted: 1/14/2020
Job Status: Full Time
Job Reference #: 149421
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 Medical Affairs trainer collaborates with the departmental management team to assess, plan, develop and implement orientation and onboarding programs, new system or program training and re-training, and educate/re-educate staff at Community Health Choice and Sendero (for which we are a third party administrator) on the appropriate use of Policies, evidence-based guidelines, or other authorization criteria as adopted by the health plan. The trainer also facilitates education, training and re-training on appropriate telephone skills to staff who regularly handle incoming or outbound calls.
In addition, the trainer works with the departmental management team to develop and implement regular Inter-rater Reliability Reviews for clinical staff whose job includes a UM function to ensure consistent application of Policies, evidence-based guidelines, or other authorization criteria as adopted by the health plan.

QUALIFICATIONS:

  • BSN preferred with active Texas nursing license.
  • Three years experience in a managed care health plan
  • Two years' experience as a trainer are preferred

OTHER SKILLS:
Exceptional Verbal communication skills
Writing /Composing/ Correspondence/Reports
Working familiarity with Milliman (MCG) and InterQual criteria required.

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

CHC Clinical

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!