Senior Director, Case Management

Houston Methodist•Katy, TX

About The Position

Sets the strategic vision and administration and is responsible for multiple budgets (operational and capital) and/or directs work that has significant financial implications including high-level oversight of the activities within the assigned functional area(s), ensuring quality, productivity, functional excellence, and efficiency to accomplish strategic and operational objectives. Directs, develops, and implements strategic and operational/high-level projects and processes through independent/highly autonomous work or through the facilitation of work teams to enable the effective and efficient completion of objectives. Oversees and ensures development for staff to meet overall objectives in terms of quality, service, and cost-effectiveness. Provides timely guidance and feedback to help others strengthen specific knowledge/skill areas needed to accomplish a task or solve a problem. Provides a functional area oversight guidance and directs management responsibilities of selection, scheduling, supervision, retention, and evaluation of employees. Reviews metrics for the function on a holistic basis. Meets or exceeds threshold goal for department turnover and/or system metrics on employee engagement indicators. Provides leadership and communication to maintain a competent and engaged employee group by conducting function leadership meetings to review policies and procedures and operational matters, rounding on all direct reports, completing performance appraisals, conducting new hire feedback sessions, coaching/corrective counseling, and providing recognition/commendations to achieve desired outcomes. Ensures information pertinent to function operations cascades appropriately to each entity. Identifies opportunities and takes action to build strategic relationships between one's functional area and other areas, teams, departments, and units to achieve business goals. Drives the promotion of teamwork within and between entities and departments; participates and/or leads system function process improvements as needed. Collaborates with HMCPA on care transition and utilization management initiatives. Provides strategic vision and execution for case management and utilization review across all hospitals and central departments. Establishes clear expectations for leadership performance, operational benchmarks, and accountability frameworks for hospital CM Directors and Central UR Director. Oversees functional area department operations, designated projects, schedules, and activities as needed to ensure that system goals or objectives are accomplished within the prescribed time frame. Sets priorities and functional standards, giving direction to function leadership and staff as necessary to ensure the best possible delivery of service and high customer/patient satisfaction. Drives department service standards and activities to impact department and/or system score for patient/customer-based satisfaction, through role modeling and fostering accountability. Serves and actively participates on various entity committees as a voice for the functional area. Oversees system throughput, escalation pathways, interdisciplinary rounding standards, and progression of care metrics. Expands and standardizes the preferred post-acute provider network across the system. Strengthens SDoH screening, intervention, and documentation strategies in alignment with population health initiatives. Ensures a safe and effective working environment; monitors and/or revises the department safety plan and/or any specific accreditation/regulatory required safety guidelines. Responsible for ensuring leaders in the functional area stay abreast of staff maintenance of credentials and competencies, per accrediting/licensing agency and/or department guidelines as applicable. Establishes and maintains a functional area alignment of policies, processes, and goals. Employs a proactive approach in the optimization of safe outcomes and information systems by monitoring and improving the system-wide workflow and enhancing operations, using peer-to-peer accountability and identifying solutions via collaboration. Designs and implements functional area process improvements utilizing tools such as lean principles. Role models situational awareness, using teachable moments to improve safety. Responsible for ensuring leaders in the functional area stay abreast of employee compliance to policies and procedures and perform associated actions upon non-compliance (i.e., licensure/certification compliance, focal point review requirements, disaster plan, in-services, influenza immunization, wage and hour, standard hours, timely termination submission, timely timecard approval, etc.). Promotes enterprise adoption of real-time data reporting and analytics to drive daily case progression activities. Ensures standardized, data-driven practices system-wide that align with Houston Methodist's mission and quality priorities. Ensures consistency and compliance across hospital-based and centralized UR functions. Oversees audit readiness, internal reviews, and corrective action plans related to medical necessity and discharge planning compliance. Provides input on the development and management of operational and capital budgets, approvals, and ongoing maintenance of the department(s), ensuring operation in a cost-effective manner. Proactively identifies and plans for capital needs related to current equipment and future system projects. Ensures staffing plans and schedules meet system needs that reflect understanding of the importance of cost-effectiveness. Creates functional area strategies to achieve financial target and staffing needs, through optimizing productivity, supply/resource efficiency, minimizing incidental overtime and overtime percentage, and other areas according to functional area specifications. Performs vendor management functions and oversees contract negotiation, contract development, and conformance to contract procedures and evaluation of expenditures. Collaborates with Revenue Cycle, Compliance, and Payor Relations to analyze denial trends and guide payor negotiations. Implements policies and practices that reduce readmissions, prevent delays in discharge, and minimize observation status misuse. Champions utilization analytics and real-time dashboards to proactively manage authorization workflows, appeals, and peer reviews. Identifies, designs, and ensures implementation of innovative solutions for the functional area. Proactively participates in task forces and committees. May represent HM at assigned community or professional organization meetings. Drives change initiatives, maintaining effectiveness when experiencing major changes in work responsibilities or environment; adjusts effectively to work within new work structures, processes, requirements, or cultures. Partners effectively with stakeholders as appropriate. Ensures own career discussions occur with appropriate management. Completes and updates My Development Plan (MDP) on an ongoing basis. Conducts conversations with direct reports on their development and MDP. Drives adoption of a system approach that is progressively seeing the future of case management. Mentors emerging leaders and promotes professional certification and engagement in national organizations (ACMA, CMSA). Evaluates and scales staff workflow improvements related to new digital tools, post-acute referral platforms, and workflow automation technologies. Leads system-wide forums to promote best practice sharing, cross-facility alignment, and continuous improvement. Leads interoperability initiatives to bridge case management functions across EHR, payer systems, and external providers.

Requirements

Master's degree or higher from an accredited school of Nursing
Seven years of experience in case management, utilization review, or care coordination, including five years progressive leadership people management experience
RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure - Must obtain permanent Texas license within 60 days (if establishing Texas residency)
Magnet ANCC-recognized Case Management certification
Magnet ANCC-recognized Leadership certification
Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through ongoing skills, competency assessments, and performance evaluations
Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially about activities impacting patient or employee safety or security
Demonstrates the ability to interact with others in a way that gives them confidence in one's intentions and those of the organization
Ability to use appropriate interpersonal styles and techniques to gain acceptance of ideas or plans; modifying one's own behavior to accommodate tasks, situations and individuals involved
Possesses strategic vision with the ability to execute at a system level
Demonstrates leadership qualities and critical thinking through self-direction initiative and effective interpersonal skills and oral/written communication skills
Ability to identify and understand issues, problems, and opportunities, comparing data from different sources to draw conclusions; using effective approaches for choosing a course of action or developing appropriate solutions; taking action that is consistent with available facts, constraints and probable consequences
Extensive knowledge of regulatory and accreditation agency requirements that impact functional area; stays abreast of industry changes
Demonstrates highly effective communication skills—strong written communications and platform presentation abilities
Ability to work effectively in a fast-paced environment
Demonstrates flexibility and adaptability in the workplace
Capable of leading teams/facilitating groups, building consensus and garnering highest confidence in professionalism and work product by senior leadership
Ability to work under pressure and balance many competing priorities; highly responsive and solution/action oriented
Proficiency in spreadsheet, word processing, and presentation software
Maintains a positive and supportive attitude and demeanor
Professional handling of exposure to confidential/sensitive information
Proven expertise in throughput optimization, denials management, and team leadership across diverse care settings

Nice To Haves

Demonstrated success leading multi-site or enterprise-level programs preferred
Participation in ACMA, CMSA, or other national case management organizations encouraged

Responsibilities

Sets the strategic vision and administration and is responsible for multiple budgets (operational and capital) and/or directs work that has significant financial implications including high-level oversight of the activities within the assigned functional area(s), ensuring quality, productivity, functional excellence, and efficiency to accomplish strategic and operational objectives.
Directs, develops, and implements strategic and operational/high-level projects and processes through independent/highly autonomous work or through the facilitation of work teams to enable the effective and efficient completion of objectives.
Oversees and ensures development for staff to meet overall objectives in terms of quality, service, and cost-effectiveness.
Provides timely guidance and feedback to help others strengthen specific knowledge/skill areas needed to accomplish a task or solve a problem.
Provides a functional area oversight guidance and directs management responsibilities of selection, scheduling, supervision, retention, and evaluation of employees.
Reviews metrics for the function on a holistic basis.
Meets or exceeds threshold goal for department turnover and/or system metrics on employee engagement indicators.
Provides leadership and communication to maintain a competent and engaged employee group by conducting function leadership meetings to review policies and procedures and operational matters, rounding on all direct reports, completing performance appraisals, conducting new hire feedback sessions, coaching/corrective counseling, and providing recognition/commendations to achieve desired outcomes.
Ensures information pertinent to function operations cascades appropriately to each entity.
Identifies opportunities and takes action to build strategic relationships between one's functional area and other areas, teams, departments, and units to achieve business goals.
Drives the promotion of teamwork within and between entities and departments; participates and/or leads system function process improvements as needed.
Collaborates with HMCPA on care transition and utilization management initiatives.
Provides strategic vision and execution for case management and utilization review across all hospitals and central departments.
Establishes clear expectations for leadership performance, operational benchmarks, and accountability frameworks for hospital CM Directors and Central UR Director.
Oversees functional area department operations, designated projects, schedules, and activities as needed to ensure that system goals or objectives are accomplished within the prescribed time frame.
Sets priorities and functional standards, giving direction to function leadership and staff as necessary to ensure the best possible delivery of service and high customer/patient satisfaction.
Drives department service standards and activities to impact department and/or system score for patient/customer-based satisfaction, through role modeling and fostering accountability.
Serves and actively participates on various entity committees as a voice for the functional area.
Oversees system throughput, escalation pathways, interdisciplinary rounding standards, and progression of care metrics.
Expands and standardizes the preferred post-acute provider network across the system.
Strengthens SDoH screening, intervention, and documentation strategies in alignment with population health initiatives.
Ensures a safe and effective working environment; monitors and/or revises the department safety plan and/or any specific accreditation/regulatory required safety guidelines.
Responsible for ensuring leaders in the functional area stay abreast of staff maintenance of credentials and competencies, per accrediting/licensing agency and/or department guidelines as applicable.
Establishes and maintains a functional area alignment of policies, processes, and goals.
Employs a proactive approach in the optimization of safe outcomes and information systems by monitoring and improving the system-wide workflow and enhancing operations, using peer-to-peer accountability and identifying solutions via collaboration.
Designs and implements functional area process improvements utilizing tools such as lean principles.
Role models situational awareness, using teachable moments to improve safety.
Responsible for ensuring leaders in the functional area stay abreast of employee compliance to policies and procedures and perform associated actions upon non-compliance (i.e., licensure/certification compliance, focal point review requirements, disaster plan, in-services, influenza immunization, wage and hour, standard hours, timely termination submission, timely timecard approval, etc.).
Promotes enterprise adoption of real-time data reporting and analytics to drive daily case progression activities.
Ensures standardized, data-driven practices system-wide that align with Houston Methodist's mission and quality priorities.
Ensures consistency and compliance across hospital-based and centralized UR functions.
Oversees audit readiness, internal reviews, and corrective action plans related to medical necessity and discharge planning compliance.
Provides input on the development and management of operational and capital budgets, approvals, and ongoing maintenance of the department(s), ensuring operation in a cost-effective manner.
Proactively identifies and plans for capital needs related to current equipment and future system projects.
Ensures staffing plans and schedules meet system needs that reflect understanding of the importance of cost-effectiveness.
Creates functional area strategies to achieve financial target and staffing needs, through optimizing productivity, supply/resource efficiency, minimizing incidental overtime and overtime percentage, and other areas according to functional area specifications.
Performs vendor management functions and oversees contract negotiation, contract development, and conformance to contract procedures and evaluation of expenditures.
Collaborates with Revenue Cycle, Compliance, and Payor Relations to analyze denial trends and guide payor negotiations.
Implements policies and practices that reduce readmissions, prevent delays in discharge, and minimize observation status misuse.
Champions utilization analytics and real-time dashboards to proactively manage authorization workflows, appeals, and peer reviews.
Identifies, designs, and ensures implementation of innovative solutions for the functional area.
Proactively participates in task forces and committees.
May represent HM at assigned community or professional organization meetings.
Drives change initiatives, maintaining effectiveness when experiencing major changes in work responsibilities or environment; adjusts effectively to work within new work structures, processes, requirements, or cultures.
Partners effectively with stakeholders as appropriate.
Ensures own career discussions occur with appropriate management.
Completes and updates My Development Plan (MDP) on an ongoing basis.
Conducts conversations with direct reports on their development and MDP.
Drives adoption of a system approach that is progressively seeing the future of case management.
Mentors emerging leaders and promotes professional certification and engagement in national organizations (ACMA, CMSA).
Evaluates and scales staff workflow improvements related to new digital tools, post-acute referral platforms, and workflow automation technologies.
Leads system-wide forums to promote best practice sharing, cross-facility alignment, and continuous improvement.
Leads interoperability initiatives to bridge case management functions across EHR, payer systems, and external providers.