At Houston Methodist, the Sr Director Case Management position is responsible for providing executive leadership and strategic oversight for all hospital-based Case Management Directors and the Central Utilization Review Director across the system. This position is responsible for the integration and advancement of a unified case management model grounded in clinical excellence, throughput efficiency, care transitions, and denials prevention. A champion of a progressive care management model, the Sr Director Case Management position promotes innovative strategies while fostering interprofessional collaboration across clinical and administrative domains. This position leads enterprise-wide initiatives aimed at optimizing patient progression of care, aligning utilization review practices, enhancing discharge planning processes, and strengthening compliance with CMS Conditions of Participation. The Sr Director Case Management position will interface with system leadership, medical staff, physician advisors, population health, revenue cycle, and post-acute networks to ensure high-performance outcomes, efficient use of resources, and superior patient experiences.

The Sr Director position has a direct report to a VP level or above and directs work that has a significant impact on the organization and strategic goals. This position leads or directs key programs; large scope (i.e., system-wide, TMC, or all community hospitals). The scope for the Sr Director position involves setting the strategic vision and administration and has responsibility 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. In addition, the Sr Director position is accountable for employee engagement, adequate staffing levels, budget development and compliance, and developing and implementing policies and procedures to ensure a safe and effective work environment. This position also ensures training, monitoring and operations initiatives are implemented which secure compliance with ethical and legal business practices and accreditation/regulatory/government regulations. The Sr Director position may serve in lieu of an entity director for the assigned functional area(s). This position may also have direct reports to include director-level employees.

PATIENT AGE GROUP(S) AND POPULATION(S) SERVED
Refer to departmental "Scope of Service" and "Provision of Care" plans, as applicable, for description of primary age groups and populations served by this job for the respective HM entity.

HOUSTON METHODIST EXPERIENCE EXPECTATIONS

• Provide personalized care and service by consistently demonstrating our I CARE values:
  • INTEGRITY: We are honest and ethical in all we say and do.
  • COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
  • ACCOUNTABILITY: We hold ourselves accountable for all our actions.
  • RESPECT: We treat every individual as a person of worth, dignity, and value.
  • EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.

• Practices the Caring and Serving Model

• Delivers personalized service using HM Service Standards

• Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)

• Intentionally collaborates with other healthcare professionals involved in patients/customers or employees' experiential journeys to ensure strong communication, ease of access to information, and a seamless experience

• Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job

• Actively supports the organization's vision, fulfills the mission and abides by the I CARE values

PEOPLE ESSENTIAL FUNCTIONS

• 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.

SERVICE ESSENTIAL FUNCTIONS

• 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.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• 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.

FINANCE ESSENTIAL FUNCTIONS

• 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.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

• 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.

This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.

EDUCATION

• Master's degree or higher from an accredited school of Nursing

WORK EXPERIENCE

• Seven years of experience in case management, utilization review, or care coordination, including five years progressive leadership people management experience

• Demonstrated success leading multi-site or enterprise-level programs preferred

LICENSES AND CERTIFICATIONS - REQUIRED

• RN - Registered Nurse - Texas State Licensure -- Compact Licensure - Must obtain permanent Texas license within 60 days (if establishing Texas residency) AND
• Magnet ANCC-recognized Case Management certification
• Magnet ANCC-recognized Leadership certification within 1 year

KNOWLEDGE, SKILLS, AND ABILITIES

• 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

• Participation in ACMA, CMSA, or other national case management organizations encouraged

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

• Uniform No
• Scrubs No
• Business professional Yes
• Other (department approved) No

ON-CALL*
*Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.

• On Call* No

TRAVEL**
**Travel specifications may vary by department**

• May require travel within the Houston Metropolitan area Yes
• May require travel outside Houston Metropolitan area No

Houston Methodist (HM) is one of the nation’s leading health systems and academic medical centers.  HM consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the heart of the Texas Medical Center, and seven community hospitals throughout the greater Houston metropolitan area.  HM also includes an academic institute, a comprehensive residency program, a global business division, numerous physician practices and several free-standing emergency rooms and outpatient facilities.  Overall, HM employs over 25,000 employees.   Houston Methodist is supported by a wide variety of business functions that operate at the system level to help enable clinical departments to provide the best patient care and service in a spiritual environment.

 

In 2019 Houston Methodist and its physicians treat more than 6,333 international patients from more than 76 countries. Houston Methodist Global Health Care Services’ consulting and education divisions also provide advisory services and training and development to health care organizations around the world.