Director Care Management - Health Plan Admin

Summary:

Under the direction of the VP Network Operations, the Director of Care Management is directly responsible for the development, management, and oversight of Care Management and Post-Acute functions for Population Health, CHRISTUS Health Quality Care Alliance (ACO), and CHRISTUS Quality Network (CIN). The Director ensures professional and consistent application of CHRISTUS Health Care Management, Post-Acute and ACO/CIN strategies across customer populations in accordance with accrediting and regulatory standards.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.

• Responsible for the daily oversight of Care Management operations to include personnel management of department staff

• Responsible for developing care management and post-acute programs that apply to the CHRISTUS Health Plan, Population Health plans, ACO and Clinically Integrated Network Payer contracts, upholding the CHRISTUS mission, vision and values, healthcare science, incentives, and information to improve Care Management and assist consumers and their support system to become engaged in a collaborative process designed to manage medical/social/mental health conditions more effectively

• Assists with the development of the CHRUSTUS Health Care Management Framework that is used to design care management programs and quaiity outreach programs to enhance consistency in services provided and reporting

• Assists with the outline and definition of the key components of a comprehensive care management program and provides examples of tools and strategies that can be used by CHRISTUS Health Plan/Population Health in designing programs to effectively meet the needs of beneficiaries with complex and special needs

• Ensures State and Federal regulatory reporting, contractual compliance, oversight of related delegated vendor functions, in addition to Care Management and Post-Acute operations, network supervision and staff management of Care Management reviews, Case Management, and coordination of linked and carved out service functions

• Ensures all functions are operating in accordance with the organization's mission, values and strategic goals are focused on continuous improvement; and are provided in a manner that is responsive and sensitive to the needs of the CHRISTUS Health patient population served

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

• Works collaboratively with their facility’s executive leadership, medical directors, managed care, operations, finance, and performance excellence to identify, develop, implement and monitor programs and processes

• The Director Care Management will be responsible for fostering relationships with employed and aligned physicians and providers involved in CHRISTUS ACOs, clinically integrated networks, and CHRISTUS Health Plan products.

• Reports on program effectiveness and quality performance to the Ministries along with their local Executive leaders

• Responsible for facility Care Management clinical compliance from regulatory bodies such as CMS, HHSC, and DOD

• Responsible for their facility’s Care Management department budgets

• Demonstrates ability to lead and motivate facility clinical and administrative teams to achieve specific objectives

• Demonstrates ability to understand and analyze complex business problems and apply cost effective solutions

• Maintains strong critical thinking skills, ability to make tough decisions and prioritization skills required

• Demonstrates successful experience working with multi-disciplinary teams in and across functional and organizational boundaries

• Deomnstrates an ability to foster adoption of clinical technology and care delivery support systems across a range of environments and clinical contexts for all clinical applications

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

Requirements:

• Bachelor's Degree required
• Demonstrates effective communication skills when writing and speaking.
• Demonstrates ability to set and meet established goals and objectives.
• Proficiency with Word Processing, costs effectiveness analysis
• Requires a minimum of 3-5 years full-time acute care nursing or social work experience
• At least 2 years in Care Management or Utilization Management experience required
• At least 3 years of leadership experience required
• RN in state of employment or compact
• Case Management Certification Preferred

Work Type:

Full Time

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