Director of Case Management
We're working on behalf of a not-for-profit healthcare organization that boasts more than 60 primary, specialty, and urgent care locations throughout Texas. For nearly 100 years they have worked to improve the health of children from across our primary service area of Denton, Hood, Johnson, Parker, Tarrant and Wise counties.
The health system combines the art of caring with leading technology and extraordinary collaboration to provide exceptional care for every child. This has earned them a strong, far-reaching reputation with patients traveling from around the country and the globe to receive life-saving pediatric care. The healthcare system is honored to continually receive recognition for our outstanding efforts and outcomes in pediatric health care.
Looking for a great opportunity? We seek a Texas licensed Registered Nurse with strong leadership experience in case management and utilization reivew for the role of Director of Care Management. In this role you will responsible for the planning, organizing, implementation, and management of the health plan's medical management functions. This position is also responsible for monitoring the Care Management Program and LTSS Program to assure compliance with the requirements of external regulatory and accreditation agencies. You will develop and maintain policies and procedures for the Care Management Program, including utilization review (precertification, concurrent, retrospective), discharge planning, catastrophic case management, long term services and supports, and case management for disease management programs. You will maintain daily oversight of all Clinical Programs to ensure compliance with departmental policies and procedures as well as all contractual and regulatory requirements. You will analyze trends in variances and make appropriate recommendations for further review or action. You will prepare and submit written monthly medical management data in accordance with Health Planreporting requirements. Candidates must have a Bachelors degree in Nursing and be licensed as an RN in the state of Texas (or have the ability to gain this licensure). Master's degreepreferred. Must have 8-10 years in a managed care environment. Ten years of clinical experiencerequired, preferably in a pediatric environment. Must have a strong track record of clinical utilization and care program management, general management, supervisory team building and leadership skills. Must have experience in LTSS program management. Must have excellent time management and prioritization skills to focus on multiple projects simultaneously and adapt to change. Must have excellent oral and written communication skills. Must have strong personal computer skills, including working knowledge of Microsoft Office suite.
Highly competitive compensation and benefits. Relocation assistance is available. This is a great opportunity to join a healthcare leader that is all about making a difference. It’s about providing the highest quality patient care by placing the needs of patients first.