Director of Care Management

Texas Children’s Health Plan is searching for a Director of Care Management — someone who works well in a fast-paced setting. In this position, you will oversee the care management functions for the Health Plan. Establish and maintain the necessary framework and the required processes to coordinate programs to address the clinical needs of the health plan members and support members through the delivery system.

Qualifications:
-Bachelor’s and Master’s Degree in Nursing, Social Work, Business, or Healthcare Required
-RN, LMSW, LCSW Licenses and PA Certification Required
-5 years of managed care experience, including 3 years of management/leadership experience required
-Pediatric experience preferred

Responsibilities:
-Provide leadership in the development, direction, execution, and evaluation of an effective care management program that supports the delivery of quality healthcare in the most appropriate and effective manner, meeting the obligations of contractual and regulatory requirements
-Develop systems to ensure effective coordination between care management, quality, claims, customer service and provider relations and network contracting
-Ensure members enter at the optimal point in the care continuum and access appropriate levels of care with the goal to maximizing health status and financial outcomes
-Establish readiness plan for product expansion, assimilation and accreditation review
-Work with Chief Medical Officers to identify and establish best practice models which are cost effective and provide quality service to members
-Contribute to effective communication through operations meeting participation, advisory committee participation, conducting studies and reporting results
-Partner intentionally and strategically with care coordination leadership across the organization, leveraging data to drive decision making, in order to ensure consistent execution of care coordination vision across entities

Founded in 1996, Texas Children’s Health Plan is the nation’s first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children’s Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children’s Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.

To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.

Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children’s without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

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