Harris Health is a nationally recognized health system comprising three teaching hospitals and an extensive network of ambulatory care centers serving the people of Harris County, Texas, since 1966. Staffed by the faculty, fellows and residents from two nationally ranked medical schools, Baylor College of Medicine and The University of Texas Health Science Center at Houston (UTHealth), Harris Health is the first healthcare system in Houston to receive the prestigious National Committee for Quality Assurance (NCQA) designation for its network of patient-centered medical homes.
Each year, Harris Health provides more than 1.8 million total outpatient visits through its more than 40 ambulatory care facilities. Additionally, Harris Health sees more than 177,000 emergency visits at its Level 1 and Level 3 trauma centers and 35,000 hospital admissions through its three hospitals: Ben Taub, LBJ and Quentin Mease.
Established by voter referendum to enhance the level of charity care available in the community, Harris Health System has often received national recognition for serving those in need and for its achievements in operational excellence, such as being named to the 2011, 2012, 2013 and 2014 Most Wired Hospitals lists by the American Hospital Association’s Hospitals & Health Networks magazine.
Additionally, Harris Health System is pleased that each of its three hospitals — Ben Taub, Lyndon B. Johnson and Quentin Mease — achieved Pathway to Excellence™ designation by the American Nurses Credentialing Center.
Medical Director, Case Management
Serves an integral role to promote effective resource utilization and quality of care for Harris Health System patients. Adds value for our patients through case management and identifying utilization-related performance improvement opportunities to improve the effectiveness and efficiency of care provided to our patients. Assures the appropriateness of hospitalization, continued stay, and use of resources. Conducts clinical review on cases referred by utilization and case management staff in accordance with the hospital's objectives for assuring quality patient care, effective and efficient utilization of health care services, and to meet regulatory requirements. Meets with case management, quality, and medical staff to discuss concurrent case reviews, trending data, and initiatives for process improvement. Interacts and serves as a resource for medical staff pertaining to medical necessity, continued stay, and appropriate use of resources. Furthermore, assists in coordinating, evaluating, and monitoring performance improvement projects that impact patient safety, patient progression, clinical effectiveness, capacity management, care coordination, and clinical outcomes. Serves as a resource to the medical staff regarding federal and state utilization and quality regulations. Medical Director, Case Management will act as a liaison between the CDI specialists, HIM, and Pavilion's medical staff to facilitate accurate and complete documentation for coding and abstracting of clinical data, capture of severity / acuity, risk of mortality, and DRG assignment. Will review all provider liable cases and develop plans to eliminate future PL cases.
Education/Specialized Training/Licensure: Graduate of an accredited medical school (MD/DO) and completion of an accredited residency program required. Additional education in quality, utilization review, and case management through continuing medical education programs and self-study required. Current or ability to obtain Texas medical license. Familiarity with CMS regulations preferred.
Work Experience (Years and Area): 5 yrs recent experience in hospital-related clinical practice required. Utilization management experience as a member of a Utilization Review Committee or past medical director, case management experience preferred. Quality experience through participation in Quality/PI committees preferred. Prior Epic EMR experience preferred; prior medical necessity software reference tool experience preferred.
Management Experience (Years and Area): Experience in Academic Medical hospital environment preferred
Equipment Operated:Computer, telephone, fax
Above Average Verbal (Heavy Public Contract)
Exceptional Verbal (e.g., Public Speaking)
Writing /Composing - (Correspondence / Reports)
Analytical, Mathematics, Medical Terms, Research, Statistical, P.C., MS Word, MS Excel, MS Access
Doctorate Major: MD or DO
Work Schedule: Flexible, On-Call
Other Requirements:Prior Epic EMR experience preferred; Prior medical necessity software reference tool experience preferred
For formal consideration please click here to apply.
Benefits and EEOC Harris Health System benefits program is designed to provide you with more flexibility and choices in meeting your specific needs. Harris Health System benefits program allows you to protect your income in case of illness, death and disability, and to help you save for retirement.
It is the policy of Harris Health System to provide equal opportunity for all applicants for employment regardless political affiliation, race, color, national origin, age, sex, religious creed or disability. Applicants may request any reasonable accommodation(s) to participate in the application process.
Internal Number: 143160
About Harris Health System
The Harris Health System is a fully integrated healthcare system that cares for all residents of Harris County, Texas. We are the first accredited healthcare institution in Harris County to be designated by the National Committee for Quality Assurance as a Patient-Centered Medical Home, and are one of the largest systems in the country to achieve the quality standard. Our system includes 23 community health centers, five school-based clinics, a dental center and dialysis center, mobile health units, a rehabilitation and specialty hospital and two full-service hospitals.Ben Taub Hospital is a world renowned Level I Trauma Center with 586 licensed acute-care beds and provides a wide range of specialty care outpatient services. Lyndon B. Johnson Hospital is a 328 licensed bed acute-care hospital with a newly expanded Level III trauma center and a distinguished regional center for neonatal intensive care for high-risk deliveries.Harris Health is a teaching system for Baylor College of Medicine and The University of Texas Health Science Center at Houston (UTHealth). We train the next generation of healthcare providers on the latest medical procedures and technological breakthroughs.With... our fully integrated electronic medical records system, we offer patients the convenience and assurance that their medical history is accurate, safe and available when and where it is needed. Our Medical Home designation ensures that we offer a full range of preventive, specialty and acute care services for the entire family.