Location(s)
WILL THIS HIRE NEED TO REPORT TO A SPECIFIC LOCATION?
Yes, they must report in-person to a specific location
COUNTRY
United States of America
CITY
Houston
STATE
TX
POSTAL CODE
77030
Monetary
Confidential
CURRENCY
$ USD
SALARY MINIMUM
$141,128.00
SALARY MAXIMUM
$176,404.00
SIGNING BONUS
No
RELOCATION PACKAGE
Full
Must-Haves
1
LCSW preferred and Certified Case Manager (CCM), Accredited Case Manager (ACM) or
2
Fellowship of the American Academy of Case Management (FAACM) required .
3
Current and valid license to practice as a Registered Nurse in the state of Texas or Current and valid Texas license as a Master’s Social Worker (LMSW) required,
4
Minimum five (5) years’ experience in utilization management, case management, discharge planning or other cost/quality management program
5
Three (3) years of experience in hospital-based nursing or social work preferred
Nice-To-Haves
1
Seeking someone that has worked with a large size organization - 850-900 beds

Job Description

The Director of Care Management is responsible and accountable to work with the Directors of Case Management on the implementation of the case management program at the local level. The components/roles of the inpatient case management program consist of the following: Care Facilitation, Utilization Management, Case Management and Discharge Planning.



The Director is responsible for overseeing/suggesting the development of systems and processes for care/utilization management at the local level. In addition, the Director is responsible for monitoring the progress of hospital department activities related to discharge planning and clinical quality improvement. The Director works with the local level Directors on matters that impact resource utilization and promotes the effective and appropriate use of hospital resources. The Director supports the collection, analysis and reporting of financial and quality data related to utilization management, quality improvement and performance improvement. The Director promotes interdisciplinary collaboration, fosters teamwork and champions service excellence.



Minimum Qualifications

Education: Bachelors of Nursing (BSN) or Masters Social Work (MSW). Masters degree preferred

Licenses/Certifications:



Current and valid license to practice as a Registered Nurse in the state of Texas or
Current and valid Texas license as a Master’s Social Worker (LMSW) required,
LCSW preferred and Certified Case Manager (CCM), Accredited Case Manager (ACM) or
Fellowship of the American Academy of Case Management (FAACM) required .
Experience/ Knowledge/ Skills:



Minimum five (5) years’ experience in utilization management, case management, discharge planning or other cost/quality management program
Three (3) years of experience in hospital-based nursing or social work preferred
Knowledge of leading practice in clinical care and payor requirements
Self-motivated, proven communication skills, assertive
Background in business planning, and targeted outcomes
Working knowledge of managed care, inpatient, outpatient, and the home health continuum, as well as utilization management and case management
Working knowledge of the concepts associated with Performance Improvement
Demonstrated effective working relationship with physicians
Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes
Effective oral and written communication skills
Principal Accountabilities



Works in collaboration with the local level Directors of Case management to plans and coordinate all aspects of the local level program.
Facilitates growth and development of the case management program consistent with enterprise wide philosophy and in response to the dynamic nature of the health care environment through benchmarking for best practices, networking, quality management, and other activities as needed.
Identifies and achieves optimal targeted clinical and financial outcomes via the case management process.
Assures that revenue, expenses, contribution margin and FTE’s meet or exceed budget.
Prepares and submits budget and related reports.
Forecasts and accurately projects expenses.
Takes corrective action to address negative variances.
Identifies and proposes capital budget items appropriately.
Participates in the annual and interim performance appraisal reviews of the Directors of Case Management.
Acts as liaison to facilitate communication and collaboration between all care partners (physicians, hospital staff, community care managers, nurses, community resources, corporate, etc.)
Leads a high performance team of “system thinkers” who incorporate leadership principles and vision in performing the functions of case management.
Uses data to drive decisions, plan, and implement performance improvement strategies for case management.
Oversees the education of physicians, managers, staff, patients and families related to the case management process at the system level.
Participates in this evolutionary process by constantly identify future needs of current customers and/or identifying potential new customers.
Responsible for the ongoing development of the Care Management program to extend beyond the acute inpatient environment.