Division Director of Care Management

St. Lukes Hospital

Houston, TX, USA

Full time

Healthcare / Hospital

Jul 7

This job is no longer accepting applications.

Responsible for the establishment and continued development of System Case Management Model including Case Managers and Social Workers strategy and approach utilizing standardized operational processes. Utilizing a matrix reporting model, this position collaborates with Facility CFOs to provide direction/resources to the facility Case Management Director/Manager. Responsible for the administration and implementation of technical and Health System standardized processes as well as ensuring the implementation and governance of all Case Management Health System policies and procedures. Acts as a liaison between System leadership and facility-level Case Management, and is primarily responsible for ensuring each hospital has effective processes, policies, and procedures for ensuring patient care is integrated between payors and providers, thus resulting in cost-effective, quality care with a focus on utilization management. This position standardizes processes where possible; ensures hospital level accountability, efficiency and productivity; and institutes and maintains Case Management best practices across the System. Actively participates in the coordination and reporting of quality enhancement activities and cost-related projects and outcomes. Actively involved in evidenced-based practice activities for both clinical and system redesign with the goal of enhancing quality and financial outcomes. Ensures up-to-date knowledge permeates Facility Case Management departments. Also responsible for providing strategic direction and leadership for the clinical documentation and quality improvement function within each local care delivery market and throughout the System. Accountable for leading the development and implementation of national standards for Clinical Documentation and Improvement Plan.


1. Oversees the daily operation of the System Case Management and Social Services programs, ensuring accountability, effectiveness, efficiency, and compliance with regulatory and accreditation agencies.

2. Serves as Clinical Advisor to Case Management across the continuum of care for all payment programs, including but not limited to participation in program development and facility network development.

3. Participates in payor relations activities and physician networking development initiatives.

4. Implements policies, institutes processes, and works with Facility leadership and Nursing to effectively manage length of stay.

5. Develops and tracks accountability metrics to ensure quality and productivity of Facility Case Management departments.

6. Acts as liaison for Information Services, Patient Financial Services, and other Corporate-level functions to ensure Case Management processes and procedures work efficiently across the Revenue Cycle.

7. Develops strategic action plans and timelines for key areas of focus including RAC preparation, ongoing physician education, physician trends, denials, discharge planning, standard order sets, ICU level of care utilization, and other areas.

8. Evaluates and ensures each facility’s level of compliance with Medicare Conditions of Participation, ensuring an effective and compliant UM committee.

9. Oversees and monitors each facility’s UM plan, ensuring compliance with CMS regulations.

10. Implements and provides oversight of CDQI operations to ensure activities are aligned with the overall strategic direction.

11. Leads the short and long-term planning process, and drives prioritization to meet the Enterprise’s financial performance goals.

12. Develops and implements best practices and consistent process/tools across care delivery businesses.

13. Ensures application of clinical algorithms within attestation process to enhance ability of providers to assess and document the complete health status of members.


Education and Licensure Required:

 *Master's Degree

*Registered Nurse (RN)


Minimum Experience:

 *Seven (7) years related experience in the discipline and five (5) years leadership experience


Minimum Knowledge, Skills, and Abilities:

 * In-depth knowledge of CMS regulations in both the inpatient and outpatient arenas is required

* Excellent written and verbal communication skills

* Broad-based knowledge regarding clinical practice, insurance and legal disciplines, hospital operations, and revenue cycle.

* Expert in problem resolution techniques.

* Excellent analytical skills, including data aggregation, analysis, interpretation, and application are required


CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S., from clinics and hospitals to home-based care and virtual care services, CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources, CommonSpirit is committed to building healthy communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen, both inside our hospitals and out in the community.

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St. Lukes Hospital

St. Luke’s Health consists of hospitals, medical groups, and emergency rooms serving Greater Houston.