Care Management Director: High-Impact Utilization

CentroMed; San Antonio (TX); On-site; USD 120,000 - 180,000; Full time

Job summary

CentroMed is seeking a Director to improve health status of high-risk individuals and reduce panel PMPM costs across hospital, ED, outside providers and pharmacy. You will oversee utilization management across the care continuum and report utilization trends and impacts to resources.

Responsibilities include managing care plans, audits, IT-enabled clinical initiatives, protocol development, staff training, and ensuring HIPAA compliance. On-site work at designated location is required.

Qualifications

• Graduation from an accredited school of Nursing.
• Current licensure (LVN or RN) with the Texas Board of Nurse Examiners.
• Master’s Degree in Health Information Management, Public Health or other health related degree preferred.

Responsibilities

• Manages and monitors care plans and timely completion of goals to ensure appropriate, timely and cost-effective care.
• Conducts audits based on defined standards and indicators.
• Provides clinical IT expertise for clinical services and evidence-based care integration.
• Participates in protocol and policy development for population health management and utilization reviews.
• Assigns registry of high-need individuals to care managers.
• Provides training to Care Managers on care planning, transitions, and resource management.

Skills

Care management

Data analytics

Public health policy

Communication skills

Bilingual/bicultural

Education

BSN

MS in Health Information Management/Public Health

Tools

MS Office

EHR applications

Job description

CentroMed is seeking a Director to improve health status of high-risk individuals and reduce panel PMPM costs across hospital, ED, outside providers and pharmacy. You will oversee utilization management across the care continuum and report utilization trends and impacts to resources.

Responsibilities include managing care plans, audits, IT-enabled clinical initiatives, protocol development, staff training, and ensuring HIPAA compliance. On-site work at designated location is required.