Director Care Management - Case Management

Christus Health; Town of Texas, San Marcos (WI, TX); On-site; USD 85,000 - 120,000; Full time

Job summary

A leading healthcare provider is seeking a Director of Care Management to oversee the Care Management Department. This role involves managing operations, ensuring compliance with regulations, and developing programs to enhance patient care. The ideal candidate will have significant experience in nursing or social work, strong leadership skills, and a commitment to improving patient engagement and care management processes.

Qualifications

• 3-5 years of acute care nursing or social work experience.
• At least 2 years in Case Management or Utilization Management.
• Minimum of 3 years of leadership experience.

Responsibilities

• Lead and manage daily Care Management operations.
• Develop programs to improve Care Management and promote patient engagement.
• Ensure compliance with State and Federal regulations.

Skills

Communication

Goal Setting

Cost Analysis

Education

Bachelor's Degree

Tools

Word Processing

Job description

Director Care Management - Case Management

This position is responsible for the direction, management, and leadership of the Care Management Department functions and processes of the hospital, including Social Work, RN Case Managers, and Utilization Review. The facility Director oversees Care Management functions and ensures timely and appropriate utilization review as set forth in COP *482.30 and discharge planning as set forth in COP *482.43, which are necessary to maintain Medicare and Medicaid participation.

CHRISTUS Santa Rosa Hospital - San Marcos, established in 1923 and located at Wonder World Drive since 1983, has a staff of over 700 associates and collaborates with more than 300 physicians to provide quality healthcare. Recognized as The Best Hospital in Hays County for over 20 years, it offers services including interventional cardiac care, robotic-assisted surgery, and specialty services such as imaging, rehabilitation, hospice, and women's health.

Responsibilities:

• Lead and manage daily Care Management operations, including personnel management.
• Develop programs aligned with CHRISTUS Health Plan's mission, vision, and values to improve Care Management and promote patient engagement.
• Assist in developing the CHRISTUS Health Care Management Framework to ensure consistency in services and reporting.
• Define key components of comprehensive care management programs and suggest tools and strategies for effective beneficiary support.
• Ensure compliance with State and Federal regulations, oversee delegated vendor functions, and manage related operations and staff.
• Align all functions with the organization's mission and strategic goals, focusing on continuous improvement and patient needs.
• Represent CHRISTUS Care Management initiatives within the organization and externally.
• Oversee clinical functions at the facility, ensuring proper management and monitoring of care determinations.
• Collaborate with facility leadership, medical directors, and other departments to develop and monitor programs.
• Report program effectiveness to regional and local leadership.
• Ensure clinical compliance with regulatory bodies such as CMS, HHSC, and DOD.
• Manage department budgets and demonstrate leadership to motivate teams.
• Analyze complex problems and implement cost-effective solutions.
• Foster adoption of clinical technology and support systems.
• Understand managed care from multiple stakeholder perspectives.

Requirements:

Education/Skills:

• Bachelor's Degree required.
• Effective communication skills in writing and speaking.
• Ability to set and achieve goals.
• Proficiency in Word Processing and cost analysis.

Experience:

• 3-5 years of acute care nursing or social work experience.
• At least 2 years in Case Management or Utilization Management.
• Minimum of 3 years of leadership experience.

Licenses, Registrations, or Certifications:

• RN or SW License in the state of employment or a compact license.

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