Director Care Management

2 weeks ago

Irving, Texas, United States Christus Health Full time

Summary:

Under the direction of the VP Network Operations, theDirector of Care Management is directly responsible for thedevelopment, management, and oversight of Care Management andPost-Acute functions for Population Health, CHRISTUS Health QualityCare Alliance (ACO), and CHRISTUS Quality Network (CIN). TheDirector ensures professional and consistent application ofCHRISTUS Health Care Management, Post-Acute and ACO/CIN strategiesacross customer populations in accordance with accrediting andregulatory standards.

Responsibilities:


• Meets expectations of the applicable OneCHRISTUSCompetencies: Leader of Self, Leader of Others, or Leader ofLeaders.


• Responsible for the daily oversightof Care Management operations to include personnel management ofdepartment staff


• Responsible for developingcare management and post-acute programs that apply to the CHRISTUSHealth Plan, Population Health plans, ACO and Clinically IntegratedNetwork Payer contracts, upholding the CHRISTUS mission, vision andvalues, healthcare science, incentives, and information to improveCare Management and assist consumers and their support system tobecome engaged in a collaborative process designed to managemedical/social/mental health conditions more effectively


• Assists with the development of the CHRUSTUS Health CareManagement Framework that is used to design care managementprograms and quaiity outreach programs to enhance consistency inservices provided and reporting


• Assists withthe outline and definition of the key components of a comprehensivecare management program and provides examples of tools andstrategies that can be used by CHRISTUS Health Plan/PopulationHealth in designing programs to effectively meet the needs ofbeneficiaries with complex and special needs


•Ensures State and Federal regulatory reporting, contractualcompliance, oversight of related delegated vendor functions, inaddition to Care Management and Post-Acute operations, networksupervision and staff management of Care Management reviews, CaseManagement, and coordination of linked and carved out servicefunctions


• Ensures all functions are operatingin accordance with the organization's mission, values and strategicgoals are focused on continuous improvement; and are provided in amanner that is responsive and sensitive to the needs of theCHRISTUS Health patient population served


•Works with key partners within the CHRISTUS Health to representCHRISTUS Care Management initiatives and/or programs


• Works collaboratively with their facility's executiveleadership, medical directors, managed care, operations, finance,and performance excellence to identify, develop, implement andmonitor programs and processes


• The DirectorCare Management will be responsible for fostering relationshipswith employed and aligned physicians and providers involved inCHRISTUS ACOs, clinically integrated networks, and CHRISTUS HealthPlan products.


• Reports on programeffectiveness and quality performance to the Ministries along withtheir local Executive leaders


• Responsible forfacility Care Management clinical compliance from regulatory bodiessuch as CMS, HHSC, and DOD


• Responsible fortheir facility's Care Management department budgets


• Demonstrates ability to lead and motivate facilityclinical and administrative teams to achieve specificobjectives


• Demonstrates ability to understandand analyze complex business problems and apply cost effectivesolutions


• Maintains strong critical thinkingskills, ability to make tough decisions and prioritization skillsrequired


• Demonstrates successful experienceworking with multi-disciplinary teams in and across functional andorganizational boundaries


• Deomnstrates anability to foster adoption of clinical technology and care deliverysupport systems across a range of environments and clinicalcontexts for all clinical applications


•Demonstrates knowledge of managed care including understanding ofthe physician, provider, payer and employer perspectives

Requirements:

  • Bachelor's Degreerequired
  • Demonstrates effective communicationskills when writing and speaking.
  • Demonstratesability to set and meet established goals andobjectives.
  • Proficiency with Word Processing,costs effectiveness analysis
  • Requires a minimumof 3-5 years full-time acute care nursing or social workexperience
  • At least 2 years in Care Managementor Utilization Management experiencerequired
  • At least 3 years of leadershipexperience required
  • RN in state of employmentor compact
  • Case Management CertificationPreferred

WorkType:

Full Time

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