Director, Care Management
On-siteHouston, Texas, United States
Job Summary
Coordinate all aspects of the local-level case management program, including care facilitation, utilization management, and discharge planning. Oversee system and process development for clinical quality improvement while monitoring department activities and resource utilization. Lead a high-performance team to achieve optimal clinical and financial outcomes, ensuring revenue and expenses meet budgetary specifications. Prepare and submit financial reports, forecast expenses, and take corrective action on negative variances. Act as liaison between care partners, physicians, and community resources to foster interdisciplinary collaboration. Use data to drive performance improvement strategies and oversee education for staff, patients, and families. Extend the Care Management program beyond the acute inpatient environment while adhering to Memorial Hermann policies and standards.
Required Qualifications
- Bachelors of Nursing (BSN) or Masters Social Work (MSW)
- Current and valid license to practice as a Registered Nurse in the state of Texas
- Current and valid Texas license as a Masters Social Worker (LMSW)
- Minimum five (5) years experience in utilization management, case management, discharge planning or other cost/quality management program
- Knowledge of leading practice in clinical care and payor requirements
- 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
Desired Qualifications
- Masters degree preferred
- Three (3) years of experience in hospital-based nursing or social work preferred
- LCSW preferred
- Certified Case Manager (CCM)
- Accredited Case Manager (ACM)
- Fellowship of the American Academy of Case Management (FAACM) required
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