Assistant Director of Care Coordination - Mother/Baby

 
Position: Assistant Director of Care Coordination - Mother/Baby

Job ID: 159720

Location: US-TX-Houston

Department: STAR KIDS - ADMIN

Talent Area: Professional - Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8am-5pm

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 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Summary:

We are searching for an Assistant Director of Care Coordination -- someone who works well in a fast-paced setting. In this position, you will provide oversight and supervision to the Care Management staff for the delivery of exceptional medical management services. This role will continually develop medical management programs in response to analysis and research of managed care trends and benchmarks as well as the strategic goals of organization and the Integrated Delivery System. You must have a passion for mother/baby care coordination.

 

Think you’ve got what it takes?



Responsibilities :

  • Plan, develop, organize, direct, and implement a coordinated approach to medical management services and meets the obligation of contractual agreements and legislative regulations
  • Participates in interdepartmental groups to represent Care Coordination needs including claims, network development, provider relations, operations, finance and quality improvement and member services
  • Provides oversight and analysis of Care Coordination services, evaluation of program offerings, health trends, and complaint findings
  • Routinely assesses productivity and accuracy of staff work product to support quality medical
  • Identifies and develops specific medical management programs as needed for members and creates educational training for staff to integrate program into existing framework
  • Responsible for provision of necessary resources to meet review requirements of State, Federal and/or accrediting standards
  • Supports the delivery of cost effective, community-based and culturally sensitive health care through development of educational and collaboration opportunities to ensure member outcomes that address values of quality, service and cost effectiveness
  • Conducts cost/benefit analysis functions as indicated or evaluation of different care settings and levels and provides documentation and authorizations in appropriate systems
  • Arranges, negotiates case agreements for and monitors services of providers through phone calls and other feedback mechanisms with parents and providers


Qualifications:

  • Being fully vaccinated against COVID-19 is required for all employees unless approved for a medical or religious exemption
  • Bachelor’s degree required
  • LCSW, LMSW or RN license from the Texas State Board of Social Work Examiners or Nurse Examiners for the state of Texas required
  • Case Management certification preferred
  • 5 years’ experience in health delivery or a managed care organization required
  • 2 years supervisory experience required


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