Population Health Management Director

POSITION SUMMARY/RESPONSIBILITIES

Provide oversight and management of the Community First Health Plans, Inc. (Community First) clinical activities and deliverables related to utilization management (UM), service coordination (SC), and behavioral health (BH) assuring all contractual, regulatory, and accreditation standards are met. Provide administrative and clinical guidance to all Population Health Management (PHM) clinical and administrative staff as assigned. Oversee the efficient utilization of resources within the schedule of benefits for Long Term Services and Support (LTSS) and acute programs for the line of business (LOB).

A Bachelor’s degree from an accredited school of professional nursing or a related field is required. A Master’s degree in nursing is preferred. Five to ten years’ experience in a health care setting is required. Three or more years in Managed Care with experience in service coordination, medical and behavioral health utilization management, medical record review, discharge planning, data analysis, and case management of acute and chronic illness. An understanding of long-term support services and service coordination for a disabled population is required. Familiarity with information and computer systems is required. Certification in Case Management (CCM), or other comparable certification, is required or must be eligible for obtaining CCM within twelve months of the date of hire (Master's degree may replace the certification requirement). Must exhibit a thorough understanding of NCQA standards and HHSC regulations. A minimum of two years of supervisory supervision and three years of managerial experience is required. Experience in an HMO setting or managed care is highly desirable. 

If a Registered Nurse must have a current, unrestricted license to practice in the State of Texas.