DIRECTOR OF CARE MANAGEMENT

JOB SUMMARY:

The Director of Care Management is responsible for measurement, analysis, coordination and implementation of initiatives and programs within Medical Affairs to achieve transformational improvements in clinical and Non-Medical Drivers of Health (NMDoH). The Director is responsible for all Care Management and Disease Management functions, the development/implementation of strategies, processes and coordination of resources to meet and ensure all strategic objectives are met, and redesigns programs aimed to improve overall health outcomes of health plan members. The Director ensures that all care management processes seamlessly integrate with existing UM, Member Services, Quality Management and Provider Relations processes and are data driven and for development of metrics and measurement of program and member health outcomes for each of these areas and ensure programmatic compliance with all contractual requirements from HHSC, TDI, CMS, URAC and other regulatory bodies. The Director is also responsible for coordination with Quality Management to ensure quality goals and improved outcomes are achieved.

MINIMUM QUALIFICATIONS:

Education/Specialized Training/Licensure: BSN degree, with active Texas RN license required. MBA, MPH, MHA and MSN preferred. Certification in Care Management required (or must receive within 18 months of employment)
Work Experience (Years and Area): Three years or more experience in Care Management in a Managed Care environment required to include LTSS programs
Management Experience (Years and Area): Five years of supervisory experience of professional staff required
Software Operated: Microsoft Office (Word, Excel, Outlook and PowerPoint)