Program Director, Case Management
The Program Director of Case Management is responsible for providing consultative, educational development, and support services to the acute care facilities and affiliated networks in areas of clinical excellence; case management, and improved operational efficiencies. In addition, this position will serve as a content expert for the development of the clinical information system to tie the clinical delivery to the business and operations of CHRISTUS Health entities. As part of the transition of the clinical process improvements to demonstrated improved financial outcomes, this position will have knowledge of revenue cycle process improvement.
* Provide the skills and expertise to assist in the design and execution of the clinical continuum case management for all patients, including special populations.
* Develop, implement and support a case management program with the functional integration of pre-admission screening, advance staff education, provide impatient and outpatient case management including social services, discharge planning and placement; and tailor utilization management targeted to general and high risk populations
* Provide consultative services in the areas of clinical process redesign development for facilities, regions, system leaders and clinical staff.
* Serve as a liaison between existing dedicated resources at the local level to promote shared learnings and best practice identification and communication.
* Maintain awareness of industry changes and serve as a resource for sharing national best practice models.
* Actively contribute to the development of a technology driven clinical decision support system that can monitor medical resource utilization and flag learning opportunities for improved care management.
* Assist with the design and execution of case management for special needs populations (i.e. chronically ill, frail elderly, and managed Medicaid).
* Assist in the design/development of standardized reports relative to acute episodes of care by physician, payer, diagnosis, MS-DRG, MDC, utilization, as well as variable direct and indirect costing methods to provide practical tools for providers to monitor medical resource consumption and assist in maximizing clinical quality and financial outcomes.
* Develop educational programs and tracking systems to maintain gains made with care management interventions, to include documentation and coding initiatives.
* Develop and implement an ongoing assessment/reassessment process for operational efficiencies.
* Identify resources and expertise for case management for CHRISTUS Health to encourage staff development and shared learnings across the System.
* Bachelor degree in Nursing, masters preferred in Nursing, business, or health administration.
* Knowledge of clinical information/utilization reporting
* Understanding of high risk case finding methodologies
* Excellent interpersonal communication skills
* Minimum ten (10) years experience of management and development of multi-site, cross continuum case management; with proven track record in successful clinical quality, business and cost outcomes.
* Experience in clinical information system development and report design/developing for all areas of responsibility and contributions.
* Ability to manage multiple projects and work collaboratively with CHRISTUS leaders and all associates.
C. Licenses, Registrations, or Certifications:
* Current RN License