Director Population Health RN

POSITION SUMMARY AND RESPONSIBILITIES

Provides oversight and management of the Community First Health Plans (Community First) STAR+Plus clinical activities and deliverables related to Long-Term Support Services (LTSS) utilization management (UM), and service coordination (SC) assuring all contractual, regulatory and accreditation standards are met. Provides administrative and clinical guidance to all Population Health Management (PHM) STAR+Plus clinical and administrative staff. Oversees the efficient utilization of resources within the schedule of benefits for the STAR+Plus program. Implements projects and activities to attain goals established by the Health System. Develops policies and procedures to assure compliance with Medicaid or any other agency that UH is contractually required to follow. Promotes the Health System’s mission, purpose, goals, objectives and commitment to service excellence.

EDUCATION/EXPERIENCE
         Bachelor’s degree from an accredited college or university of professional nursing or related field is required. Master’s degree is preferred. Five years experience in a health care setting is required.. An understanding of LTSS and service coordination for a disabled population is required. Fluency in MicroSoft365 applications and electronic medical management charting systems is required. Must exhibit thorough understanding of NCQA standards and HHSC regulations. Minimum three years managerial experience is required. Experience in an HMO setting or managed care is required.  

LICENSURE
If a Registered Nurse, must be licensed in the State of Texas.