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Manager Clinical Effectiveness - Case Management and Social Work

Job Ref: 23089

Talent Area: Social Work

Houston Methodist Hospital
Houston, TX 77030

Area/Department: Case Mgmt&Social Work

Employment Type: Regular

Job Type: Full-Time

Organization: Houston Methodist

Work Shift: DAY

Work Week: M - F

Company Profile

Since its founding in 1919, Houston Methodist has earned worldwide recognition. Houston Methodist is affiliated with the Weill Medical College of Cornell University and New York-Presbyterian Hospital, one of the nation's leading centers for medical education and research. Houston Methodist is consistently ranked in U.S. News & World Report’s “Best Hospital” list and was recently named the number one hospital in Texas. FORTUNE magazine has placed Houston Methodist on its annual list of “100 Best Companies To Work For” since 2006.  Houston Methodist directs millions of research dollars into patient care and offers the latest innovations in medical, surgical and diagnostic techniques. With 1,119 licensed beds, 73 operating rooms and over 5,000 employees, Houston Methodist offers complete care for patients from around the world.

Job Summary


Under direction is responsible for functional and operational aspects of the Case Management / Social Work Department, an integrated, multi-disciplinary department which supports caregivers to provide the highest quality, most clinically appropriate care to patients and while promoting the most cost-effective utilization of the hospital`s resources. Provides leadership, guidance and direction to staff. Maintains accountability for level of unit performance and results. Responsible for quality, functional excellence and contribution to accomplishment of strategic and operational objectives. Accountable for the design, implementation, training, and resources for the MIDAS+ Care Management system for the organization. Possesses the ability to interact with corporate and hospital administrators, medical staff, and defined customers related to the MIDAS+ Care Management system. Responsible for the MIDAS+ Care Management reporting system to ensure organization priorities are appropriately addressed in all facilities.


1. Participates in planning, budgeting and general management efforts for the department of which the unit is a part and stays within budget. 

2. Plans and organizes day-to-day operations, schedule and activities of the work group. Sets priorities and functional standards; gives direction to staff as necessary. 

3. Makes and executes decisions within delegated authority. Surfaces issues to management for resolution as appropriate. Participates in resolving issues outside delegated scope of authority. 

4. Provides the leadership to have a competent and satisfied employee group by doing timely performance appraisals, providing development and mentoring of subordinates and staff. Hires, coaches, Supports maximization of MIDASplus Care Management system utilization.

5. Recommends appropriate uses for the MIDASplus Care Management system. Collaborates with departmental management and/or staff, Information Technology (IT) personnel, other functional areas, and software vendors as appropriate to determine information needs and ensure timely information updates. 

6. Evaluates departmental procedures and operations as they relate to information technology and recommends changes to improve efficiency and effectiveness as appropriate. Ensures the effective use of departmental information system by coordinating initial training for new users and ongoing training departmental staff of system upgrades, changes, and new functions as necessary. 

7. Conducts special studies, performs informational analysis, and develops special reports as requested through system tools and resources. Generates reports to identify trends and opportunities for process improvement. Prepared data for presentation. Develops audit reports to identify quality issues and to identify areas for enhanced staff training. Manages Utilization Management (UM) programs including Medical Claims Review, Precertification and Reconsiderations and Appeals. Collaborates with the Director of Case Management/Social Work on Criteria and Policy Key Development, and the Prior Authorization List. Collaborates with Physician and Nursing leaders and external entities to develop, implement and evaluate UM program policies as directed and ensures UM programs are consistent with national accreditation guidelines.  Provides leadership to ensure operational effectiveness and efficiency of retrospective UM and medical claims functions to meet and exceed service-level goals and contract requirements. Oversees the quality assurance and quality improvement processes related to retrospective UM and medical claims programs. Collaborates with medical and clinical leadership to implement new processes for enhancing service levels.  Demonstrates the components of the ICARE values statements. 

8. Follows all safety rules while on the job. Reports accidents promptly and i. corrects minor safety hazards. 

9. Performs other duties as assigned. 



Bachelor`s degree required; Masters preferred (MBA or Masters in Health related field or MSW)



3-5 years previous management experience  

5 years experience in case management, social work or utilization management department or managed care/payer environment.





Patient care unit conditions.

Operating room conditions.

Universal precautions required. 

Lifting, pushing or pulling required (minimum 50 lbs.).

Extended periods of walking and standing required.

Significant potential for exposure to Latex

Equal Employment Opportunity

Houston Methodist is an Equal Opportunity Employer.

Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of  race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law.

VEVRAA Federal Contractor – priority referral Protected Veterans requested.