Director, Care Management

The Director of Care Management is responsible and accountable to work with the Directors of Case Management on the implementation of the case management program at the local level. The components/roles of the inpatient case management program consist of the following: Care Facilitation, Utilization Management, Case Management and Discharge Planning.

The Director is responsible for overseeing/suggesting the development of systems and processes for care/utilization management at the local level. In addition, the Director is responsible for monitoring the progress of hospital department activities related to discharge planning and clinical quality improvement. The Director works with the local level Directors on matters that impact resource utilization and promotes the effective and appropriate use of hospital resources. The Director supports the collection, analysis and reporting of financial and quality data related to utilization management, quality improvement and performance improvement. The Director promotes interdisciplinary collaboration, fosters teamwork and champions service excellence.

Minimum Qualifications

Education: Bachelors of Nursing (BSN) or Masters Social Work (MSW). Masters degree preferred

Licenses/Certifications:

• Current and valid license to practice as a Registered Nurse in the state of Texas or
• Current and valid Texas license as a Masters Social Worker (LMSW) required,
• LCSW preferred and  Certified Case Manager (CCM), Accredited Case Manager (ACM) or
• Fellowship of the American Academy of Case Management (FAACM) required .

Experience/ Knowledge/ Skills:

• Minimum five (5) years experience in utilization management, case management, discharge planning or other cost/quality management program
• Three (3) years of experience in hospital-based nursing or social work preferred
• Knowledge of leading practice in clinical care and payor requirements
• Self-motivated, proven communication skills, assertive
• Background in business planning, and targeted outcomes
• Working knowledge of managed care, inpatient, outpatient, and the home health continuum, as well as utilization management and case management
• Working knowledge of the concepts associated with Performance Improvement
• Demonstrated effective working relationship with physicians
• Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes
• Effective oral and written communication skills

Principal Accountabilities

• Works in collaboration with the local level Directors of Case management to plans and coordinate all aspects of the local level program.
• Facilitates growth and development of the case management program consistent with enterprise wide philosophy and in response to the dynamic nature of the health care environment through benchmarking for best practices, networking, quality management, and other activities as needed.
• Identifies and achieves optimal targeted clinical and financial outcomes via the case management process.
• Assures that revenue, expenses, contribution margin and FTEs meet or exceed budget.
• Prepares and submits budget and related reports.
• Forecasts and accurately projects expenses.
• Takes corrective action to address negative variances.
• Identifies and proposes capital budget items appropriately.
• Participates in the annual and interim performance appraisal reviews of the Directors of Case Management.
• Acts as liaison to facilitate communication and collaboration between all care partners (physicians, hospital staff, community care managers, nurses, community resources, corporate, etc.)
• Leads a high performance team of system thinkers who incorporate leadership principles and vision in performing the functions of case management.
• Uses data to drive decisions, plan, and implement performance improvement strategies for case management.
• Oversees the education of physicians, managers, staff, patients and families related to the case management process at the system level. 
• Participates in this evolutionary process by constantly identify future needs of current customers and/or identifying potential new customers.
• Responsible for the ongoing development of the Care Management program to extend beyond the acute inpatient environment.
• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermanns service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.
• Other duties as assigned.