Summary:

This job is responsible for the direction, management and leadership of ministry/regional Care Management Department functions and processes to include Social Work, RN Case Managers, and Utilization Review. This includes the functions of utilization and case management, social services, and discharge planning. The Regional Director has oversight of Care Management functions for each facility within the ministry/region and is responsible for ensuring timely and appropriate utilization review as set forth in COP §482.30 and discharge planning as set forth in COP §482.43 which is necessary to remain a participating provider with Medicare and Medicaid services. The Ministry/Regional Care Management Director may have direct oversight of the facility Care Management Directors or may share supervisory duties with the facility executive leadership. 

Responsibilities:

• Responsible for developing programs that apply the CHRISTUS Health 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
• Develops the CHRUSTUS Health Plan Care Management Framework for the ministry/region that will be used by the local/facility Care Management leaders and ensures this framework serves to improve standardization across the ministry/regional and enhance consistency in processes
• Outlines and defines the key components of a comprehensive care management program for the ministry/region and provides examples of tools and strategies that can be used by local/facility Care Management leaders to effectively meet the needs of beneficiaries with complex and special needs
• Responsible for ensuring compliance by local/facility Care Management leaders with State and Federal regulatory reporting, contractual compliance, oversight of related delegated vendor functions, in addition to Care Management operations, network supervision and staff management of Care Management reviews, Case Management, and coordination of linked and carved out service functions
• Responsible for ensuring all functions across the ministry/region are operating in accordance with the CHRISTUS mission, values, and strategic goals and that services are provided in a manner that is responsive and sensitive to the needs of the CHRISTUS Health patient population served
• Responsible for building a comprehensive care management plan for the ministry/region and aligning the work force to the appropriate initiatives and measures
• Works with key community partners across the ministry/region to develop working relationships that benefit the patients served by Christus while also ensuring regulatory compliance, and the provision of appropriate services that will improve efficiency and quality of care.
• The job is also responsible for oversight of delegated clinical functions insuring that care determinations are managed and monitored appropriately
• Reports on program effectiveness from the ministry/regional perspective to the Ministry/Regional Executive leaders as well as the Board of Directors when appropriate
• Responsible for ensuring each facility within the ministry/region is functioning in accordance with clinical compliance as defined by regulatory bodies such as CMS, HHSC, and DOD
• Supports local/facility Care Management Director with the development of and adherence to department budgets
• Must display a proven ability to understand Care Management trends and to develop initiatives that will serve the ministry/region as a whole while challenging the historical way of doing things and bringing innovation and new ideas to the Care Management function
• Must have a demonstrated ability in lead and motivate clinical and administrative teams on a system or regional scale in order to achieve specific objectives
• Must have an ability to understand and analyze complex business problems and apply cost effective solutions and anticipate potential impacts for all facilities within the ministry
• Must have strong critical thinking skills that considers each facillity within the ministry/region, success with identifying appropriate prioritization, and an ability and comfort with making tough decisions
• Demonstrated experience working with multi-disciplinary teams in and across functional and organizational boundaries
• Ability to foster adoption of clinical technology and care delivery support systems across a range of environments and clinical contexts for all clinical applications
• Demonstrated knowledge of managed care including understanding of the physician, provider, payer and employer perspectives

Requirements:

Education/Skills

• Bachelor?s degree required,Master's degree preferred.
• 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

Experience

• Requires a minimum of 3-5 years full-time acute care nursing or social work experience
• At least 2 years in Case Management or Utilization Management experience required
• At least 5 years of leadership experience required
• Requires at least 2 years? experience as a Case Management Director at the local/facility level

Licenses, Registrations, or Certifications

• Current RN or SW license in the state of Texas.
• Case Management certification preferred.

Work Schedule:

5 Days - 8 Hours

Work Type:

Full Time

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About CHRISTUS Health

CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.

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