Director of Care Management (RN) - Texas Children's Health Plan

 
Position: Director of Care Management (RN) - Texas Children's Health Plan

Job ID: 147537

Location: US-TX-Bellaire

Department: Administration-TC Health Plan

Talent Area: Registered Nurse

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p

About Texas Children's Hospital

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.   To join our community of 13,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.  

Summary:

We are searching for a Director of Care Management – someone who works well in a fast-paced setting. In this position, you’ll be responsible for overseeing the care management functions for the Health Plan. This role will be primarily responsible for establishing and maintaining the necessary framework and the required processes to coordinate programs to address the clinical needs of the health plan members and support members through the deliver system.

 

Think you’ve got what it takes?

 



Responsibilities :

 

 

  • Provides leadership in the development, direction, execution, and evaluation of an effective care management program that supports the delivery of quality healthcare in the most appropriate and effective manner, meeting the obligations of contractual and regulatory requirements

 

 

  • Represents TCHP as a knowledge leader in care management for external relationships and consultations.

 

 

  • Develops systems to ensure effective coordination between care management, quality, claims, customer service and provider relations, and network contracting

 

 

  • Ensures members enter at the optimal point in the care continuum and access appropriate levels of care with the goal to maximizing health status and financial outcomes

 

 

  • Develops an integrated care management model which incorporates continuous quality improvement and effective outreach programming

 

 

  • Plans, directs, staffs, organizes, and evaluates service models

 

 

  • Develops approaches, policies, and programs for a HMO which are based on Texas Children’s organizational goals and objectives, TCHP’s performance goals, and are based upon analysis of member and provider use patterns

 

 

  • Establishes readiness plan for product expansion, assimilation, and accreditation review

 

 

  • Works with Chief Medical Officers to identify and establish best practice models which are cost effective and provide quality service to members

 

 

  • Mentors and develops TCHP staff toward expansion of professional roles to meet the continuous challenges and changes of the healthcare environment, contractual and legislative regulations, including promoting the ability to respond effectively to innovation and capacity management

 

 

  • Contributes to effective communication through operations meeting participation, advisory committee participation, conducting studies, and reporting results

 

 

  • Partners intentionally and strategically with care coordination leadership across the organization, leveraging data to drive decision making, to ensure consistent execution of care coordination vision across entities

 

 



Qualifications:

 

 

 

  • Bachelor’s Degree in nursing

 

 

  • Master’s degree in nursing, business, or healthcare

 

 

  • Registered Nurses License issued by the Board of Nursing for the State of Texas

 

 

  • 5 years experience in healthcare management or managed care experience is required

 

 

  • Pediatrics experience is preferred

 

 

  • Knowledge of concepts and techniques central to the managed care, and care management

 

 

  • Excellent written and verbal communication skills, the ability to interact with a wide variety of individuals, and good customer service skills

 

 

  • Ability to articulate a problem and formulate a response when there is no program precedent

 

 

  • Skilled in program development and project management

 

 

  • Significant knowledge of applicable state and federal laws and regulations related to managed care practices

 

 

 

 

 

 



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