Vice President, Case Management

Med-Metrix; New York (NY); On-site; USD 180,000 - 300,000; Full time

Job summary

Med-Metrix seeks a Vice President, Case Management to lead and align case management initiatives with organizational strategy in New York. The role requires guiding utilization and transition management while ensuring HIPAA compliance and regulatory readiness across the enterprise.

The ideal candidate will possess 10+ years in acute care and case management leadership, a nursing license (NY required), and certifications in PRI/Screen and Case Management.

Qualifications

• Bachelor’s Degree in Nursing; New York State RN license.
• Master’s Degree in Nursing or related field preferred.
• Minimum of 10 years acute care clinical experience.
• Minimum of 10 years case management leadership experience.
• New York State Licensed Registered Professional Nurse.
• Certification in PRI and Screen.
• Certification in Case Management.
• Certification in Hospital Management strongly preferred.
• Broad knowledge of medical, nursing, allied health sciences, regulatory requirements, and revenue cycle.
• Proficiency in Microsoft Office Suite and case management/denials software.

Responsibilities

• Executive management of Case Management.
• Oversees Case Management and social work activities to monitor quality of care.
• Develops and implements strategy and actions plans aligned with organizational goals.
• Ensures strategies meet performance metrics and regulatory guidelines.
• Collaborates with department leaders to integrate Case Management across care continuum.
• Monitors regulatory readiness (JCAHO, federal, state).
• Maintains and revises policies for administrative and departmental case management.

Skills

Leadership

CMS knowledge

HIPAA compliance

Regulatory knowledge

Strategic planning

Education

Bachelor’s in Nursing

Master’s in Nursing (preferred)

Tools

PRI & Screen Certification

Case Management Certification

Hospital Management Certification (preferred)

MS Office

Job description

Job Purpose

The Vice President, Case Management provides leadership and direction to related to Case Management initiatives and clinical priorities. This person works collaboratively with leadership to lead strategy related to Case Management ensuring stakeholder inclusion and alignment. The Vice President, Case Management is responsible for strategic planning and the advancement of case management, to include utilization management, coordination of care and transition management. The Vice President, Case Management develops and executes operational strategies built to ensure the Case Management strategy is aligned with regulatory requirements, organizational goals and forward thinking aimed at efficiency and viability.

Duties & Responsibilities

• Executive management of Case Management
• Oversees Case Management and social work activities to monitor quality of care
• Develops and implements strategy and actions plans in alignment with the organization’s strategic planning process
• Ensures strategies developed and deployed related to performance metrics
• Ensures alignment with regulatory guidelines and organization goals
• Adjusts strategy as indicated by performance metrics and/or organization need
• Assures evidence-based practice and clinical best practice care standards, outcomes and metrics are established and held accountable
• Collaborates with other department leaders to assure the smooth integration of Case Management/Social Work services across the continuum
• Monitors and maintains JCAHO, federal and state regulatory readiness
• Actively participates in the formulation and revision of administrative and departmental case management policies and procedures
• Communicates and interprets policy additions/revisions to staff
• Other duties as assigned
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Understand and comply with Information Security and HIPAA policies and procedures at all times
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications

• Bachelor’s Degree in Nursing
• Master’s Degree in Nursing and other health care related courses – Preferred
• Minimum of 10 years acute care clinical experience
• Minimum of 10 years case management leadership experience
• New York State Licensed Registered Professional Nurse
• Certification in Patient Review Instrument (PRI) and Screen
• Certification in Case Management
• Certification in Hospital Management strongly preferred
• Broad knowledge of medical, nursing, and allied health sciences, community resources case management regulatory requirements, and the revenue cycle
• PC experience word processing, spreadsheets, and case management/denials software structures
• Strong understanding of CMS Conditions of Participation as it relates to utilization management, coordination of care and transition management
• Knowledge of HIPAA and privacy regulations, healthcare laws, regulations and standards
• Demonstrated leadership ability required
• Proficiency in Microsoft Office Suite
• Strong interpersonal skills, ability to communicate well at all levels of the organization
• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
• High level of integrity and dependability with a strong sense of urgency and results oriented
• Excellent written and verbal communication skills required
• Gracious and welcoming personality for customer service interaction

Working Conditions

• Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes
• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear. Perform light lifting (up to 15 pounds)
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress
• Work Environment: Works in a well-lighted/ventilated office setting. Subject to frequent interruptions. Minimal occupational exposure to infectious diseases, blood borne pathogens, hazardous chemicals, noxious odors, latex, or musculoskeletal injuries. Operate Office machines properly and in accordance with Hospital safety standards. Ability to work in accordance with Hospital Safety Standards

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.