Description

Summary:

This job is responsible for the direction, management and leadership of ministry/regional Care Management Department functions and processes to include Social Work, RN Case Managers, and Utilization Review. This includes the functions of utilization and case management, social services, and discharge planning. The Regional Director has oversight of Care Management functions for each facility within the ministry/region and is responsible for ensuring timely and appropriate utilization review as set forth in COP §482.30 and discharge planning as set forth in COP §482.43 which is necessary to remain a participating provider with Medicare and Medicaid services. The Ministry/Regional Care Management Director may have direct oversight of the facility Care Management Directors or may share supervisory duties with the facility executive leadership. 

Responsibilities:

• Responsible for developing programs that apply the CHRISTUS Health mission, vision and values, healthcare science, incentives, and information
  to improve Care Management and assist consumers and their support system to become engaged in a collaborative process designed to manage
  medical/social/mental health conditions more effectively.
• Develops the CHRUSTUS Health Plan Care Management Framework for the ministry/region that will be used by the local/facility Care Management
  leaders and ensures this framework serves to improve standardization across the ministry/regional and enhance consistency in processes.
• Outlines and defines the key components of a comprehensive care management program for the ministry/region and provides examples of tools
  and strategies that can be used by local/facility Care Management leaders to effectively meet the needs of beneficiaries with complex and special
  needs.
• Responsible for ensuring compliance by local/facility Care Management leaders with State and Federal regulatory reporting, contractual
  compliance, oversight of related delegated vendor functions, in addition to Care Management operations, network supervision and staff
  management of Care Management reviews, Case Management, and coordination of linked and carved out service functions.
• Responsible for ensuring all functions across the ministry/region are operating in accordance with the CHRISTUS mission, values, and strategic
  goals and that services are provided in a manner that is responsive and sensitive to the needs of the CHRISTUS Health patient population served.
• Responsible for building a comprehensive care management plan for the ministry/region and aligning the work force to the appropriate initiatives
  and measures.
• Works with key community partners across the ministry/region to develop working relationships that benefit the patients served by Christus while
  also ensuring regulatory compliance, and the provision of appropriate services that will improve efficiency and quality of care.
• The job is also responsible for oversight of delegated clinical functions ensuring that care determinations are managed and monitored
  appropriately.
• Reports on program effectiveness from the ministry/regional perspective to the Ministry/Regional Executive leaders as well as the Board of
  Directors when appropriate.
• Responsible for ensuring each facility within the ministry/region is functioning in accordance with clinical compliance as defined by regulatory
  bodies such as CMS, HHSC, and DOD.
• Supports local/facility Care Management Director with the development of and adherence to department budgets
  Must display a proven ability to understand Care Management trends and to develop initiatives that will serve the ministry/region as a whole while
  challenging the historical way of doing things and bringing innovation and new ideas to the Care Management function.
• Must demonstrate the ability to lead and motivate clinical and administrative teams at the regional or system level to achieve organizational goals.
• Must be able to analyze complex business problems, implement cost-effective solutions, and anticipate potential impacts across all ministry facilities.
• Must have strong critical thinking skills, the ability to prioritize effectively across ministry/region facilities, and the confidence to make difficult decisions.
• Demonstrated experience leading multi-disciplinary teams across functional and organizational boundaries.
• Proven knowledge of managed care with an understanding of physician, provider, payer, and employer perspectives.
• https://careers.christushealth.org/opportunity/ministry-director-care-management-290679

Requirements

• Bachelor’s degree required; Master’s degree preferred
• Strong written and verbal communication skills
• Proven ability to set and achieve established goals and objectives
• Proficiency in word processing and cost-effectiveness analysis

Experience

• Minimum of 3–5 years of full-time acute care nursing or social work experience.
• At least 2 years of case management or utilization management experience required.
• Minimum of 5 years of leadership experience required.