Community First Health Plans (CFHP) was established in 1995, by University Health System, specifically to begin providing health care coverage to the citizens of Bexar and the surrounding seven counties.

For over 20 years now, Community First has provided quality health care and has touched the lives of almost 700,000 unique individuals. We are proud to offer exceptional care for individuals and families.

University Health System- Community First Health Plans is currently seeking an experienced leader to serve as Director of Population Health Management.

Position Summary:

Oversees clinical staff in the assessment, planning, implementation, coordination, monitoring, and evaluation of utilization management and service coordination activities that require interventions for Community First members.

Implements an explicit process for managing denials, appeals, and complaints.

Directs, advises, and supports Population & Disease Management service coordination activities related to the line of business.

Supports Quality Management activities as it relates to achieving accreditation.

Why you should apply:

• We offer competitive pay
• Excellent benefits package
• We also offer advancement opportunities

Qualifications:

• • Bachelor’s degree from an accredited school of professional nursing or related field is required. Master’s degree in nursing preferred.
• • Five to ten years’ experience in a health care setting is required.
• • Minimum of two years supervisory and three years managerial experience is required.
• • Three or more years in Managed Care with experience in service coordination, medical and behavioral health utilization management, medical record review, discharge planning, data analysis, and case management of acute and chronic illness.
• • An understanding of long term support services and service coordination for a disabled population is required.
• • Familiarity with information and computer systems is required.
  • Knowledge of screening criteria such as InterQual as well as DRG, ICD-10 and CPT coding is preferred.
• • Certification in Case Management (CCM), or other comparable certification, is required, or must be eligible for obtaining CCM within twelve months of date of hire (Master’s degree may replace certification requirement).
• • Must exhibit thorough understanding of NCQA standards and HHSC regulations.

Experience in an HMO setting, or managed care is highly desirable.