Director Care Management

 
Position: Director Care Management

Job ID: 141892

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 recruiting for a Director of Care Management for Texas Children's Hospital Health Plan. 

PURPOSE: To oversee the care management functions for the Health Plan. Establishes and maintains 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 delivery system.

 

POLICY SETTING RESPONSIBILITIES: Formally responsible for setting policies associated with the job’s purpose and essential responsibilities.

 

DECISION-MAKING AUTHORITY: Routine decisions include:

  • Managerial including review, evaluation and performance appraisal of

 

 

employees

  • Selection of candidates for employment

 

 

  • Policies and Procedures; compliance accountability for regulatory requirements

 

 

  • Budgetary decisions for cost center

 

 

 

SUPERVISORY RESPONSIBILITY: Formally responsible for supervising staff with assigned area(s) of responsibility.

 



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

 

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

 

 

 

 



Qualifications:

The formal education and experience required for completely satisfactory performance in this job is:

  • A Bachelor’s degree or a Master’s degree in Nursing

 

 

  • Current RN licensure with the Board of Nursing for the State of Texas

 

 

  • Five (5) years of healthcare management or managed care experience

 

 

 

The following is preferred:

Pediatrics experience



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