Minneapolis, Minnesota
Phoenix, Arizona
Jacksonville, North Carolina
Galveston, Texas
Minneapolis, Minnesota
Bethlehem, Pennsylvania
Posted: 18-Aug-24
Location: Irving, Texas
Salary: Open
Categories:
Internal Number: 213202
Summary:
The Director of Medical Management requires strong leadership skills, strategic thinking, and a deep understanding of healthcare management principles. The incumbent will partner with the Chief Medical Director to provide strategic leadership to the Care and Disease Management and Utilization Management programs of the Health Plan. This position is responsible for all clinical aspects of Uniformed Services Family Health Plan (USFHP), Medicare Advantage, Health Exchange, and other assigned contracts, ensuring compliance with regulatory and contractual requirements. Responsibilities include the development, monitoring, and reporting of clinical programs and quality initiatives for plan performance, implementation of population-based studies, and establishment of continuous quality improvement activities within the organization.
Responsibilities:
· Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
· Demonstrates effective communication skills when writing and speaking.
· Demonstrates ability to set and meet established goals and objectives.
· Demonstrates proficiency with Word Processing, costs effectiveness analysis.
Strategic Planning:
· Develop and implement strategic plans for Care and Utilization Management programs that integrate behavioral and physical health.
· Align programs with the Health Plan?s goals and objectives.
· Identify opportunities for program enhancement and expansion to meet the evolving needs of members and beneficiaries.
Team Leadership:
· Provide guidance and support to the Care and Utilization Management teams, including managers, supervisors, care coordinators, social workers, medical directors, and other healthcare professionals.
· Foster a collaborative and positive work environment that promotes professional growth and development.
Program Development:
· Assist in the design, development, and implementation of Care Management and Utilization Management Programs.
· Ensure programs are evidence-based, culturally competent, and tailored to meet the diverse needs of the member population.
Performance & Quality Improvement:
· Monitor and evaluate the effectiveness of Care and Utilization Management programs through ongoing performance measurement and data analysis.
· Identify areas for, and implementation of, performance improvement initiatives to enhance program outcomes and efficiency.
Collaboration:
· Collaborate with cross-functional teams and other Health Plan departments, including Business Intelligence, Information Services, Claims and Configuration, Member Engagement, Provider Relations, etc., to ensure seamless coordination of care for our members.
· Establish strong partnerships with other internal and external stakeholders to enhance care delivery and promote member engagement.
Regulatory Compliance:
· Stay abreast of regulatory requirements and accreditation standards and ensure compliance with all applicable laws, regulations, and guidelines.
· Develop and implement policies and procedures to support regulatory compliance and mitigate risks.
Member Engagement:
· Develop and implement member engagement strategies to promote active participation in care management programs and empower members to take an active role in managing their health.
· Ensure timely communication and education about available resources and services.
Associate Performance: Leverage existing resources to design a dashboard to monitor and report Care and Utilization Management Associate performance and productivity.
Requirements:
Bachelor's Degree required.
3 ? 5 years of full-time acute care nursing or social work experience required.
2 years in Case Management and/or Utilization Management experience required.
3 years of leadership experience required.
Experience with Epic, Compass Rose, and Healthy Planet platforms preferred.
RN or BSW (or higher) license in the state of employment required.
Case Management Certification preferred.
Fulltime In-office. This is not a remote position
EEO is the law - click below for more information:
https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12ScreenRdr.pdf
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