To assure the appropriate and cost-effective use of hospital resources and services in delivering health care to patients and to assure the timely provision of appropriate health care services to the patient throughout the continuum and to improve patient outcomes from a given episode of care.
Baccalaureate Degree in Nursing preferred or equivalent experience
Excellent interpersonal skills applicable to the medical staff, administration, professional staff and outside reviewing agencies
Strong organizational and written communication skills
Self motivated, self-disciplined and holds self accountable for achieving goals and tactics in a timely manner.
Demonstrated hands-on leadership and operational responsibility in a large/complex healthcare environment.
Possesses strong personnel management and team building skills that result in a high performing team and excellent Associate job satisfaction.
Ability to successfully apply new learning to achieve expected outcomes.
Demonstrated excellence in negotiation, facilitation, influencing and collaboration skills.
Demonstrated understanding of financial operations and ability to meet/exceed expectations on an ongoing basis.
Integrates and interprets data from diverse sources addressing issues of moderate to high complexity.
Develops strong relationships with customers (i.e. patients, physicians and supporting departments).
Four years of actual hospital based work experience in case management/utilization review
2 years Leadership/Management/Supervisory experience
Knowledge of risk management and related issues
Understanding of credentialing process
Knowledge of current bylaws and regulations governing System facilities
Knowledge of current Federal regulations, PRO guidelines, sanction procedures, memorandums of understanding and JCAHO
Understanding of medical-legal aspects of Performance Improvement
Knowledge of clinical conditions, criteria and appropriate treatment plans provided to patients
Knowledge of insurance utilization review standards
Demonstrated facilitation skills with a working knowledge of CQI tools and techniques.
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.