VP - Case Management

Ochsner Health; New Orleans (LA); On-site; USD 110,000 - 160,000; Full time

Job summary

Ochsner Health seeks a seasoned leader to oversee Case Management and Social Services, driving strategic direction and ensuring compliance with quality and regulatory standards. The role collaborates with physicians, executives, and cross-functional teams to improve patient flow and outcomes.

The ideal candidate has extensive management experience in healthcare, a Master’s degree in a related field, and a proven ability to lead change in large organizations while focusing on patient-centered

Qualifications

• Master’s degree required or equivalent.
• 15 years of experience in Case Management or related field.
• Progressive management experience with senior leadership exposure.

Responsibilities

• Oversee Case Management and Social Services including utilization management and care transitions.
• Develop and drive strategies for continuous improvement and performance reviews.
• Set department direction and implement policies and procedures.
• Lead system training programs for staff and leaders.
• Ensure regulatory compliance and patient-centered care across teams.

Skills

Leadership & people management

Regulatory & compliance knowledge

Strategic planning

Executive communication

Collaboration across departments

Financial performance review

Presenting to leadership groups

Education

Master’s degree in business, nursing, or healthcare-related field

Job description

Exceptional care starts with exceptional people.

For us, this is more than a job– it’s a calling. It’s waking up each day, looking for ways to make a difference with a compassionate, inclusive and talented team. Ochsner empowers you to discover your passion, reach your potential, and Pursue Your Purpose. Exceptional care starts with exceptional people and teams. Together we are leading the way.

This job provides leadership and direct oversight for Case Management and Social Services. Sets the overall direction for assigned areas and develops plans to achieve goals that meet operating standards of performance. Works collaboratively with other clinical and business functions to align organization goals and review performance on a regular basis. Leads the Case Management area to ensure compliance with regulatory rules and emphasizes a patient-centered approach to care that supports our patient experience goals.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential duties.

This job description is a summary of the primary duties and responsibilities of the job and position. It is not intended to be a comprehensive or all-inclusive listing of duties and responsibilities. Contents are subject to change at the company’s discretion.

Education

Required - Master’s Degree in business, nursing, or other healthcare related field

Work Experience

Required - 15 years of experience in Case Management or related field. Progressive management experience to include frequent involvement with senior management, physicians, and outside care providers. Experience with insurance precertification, utilization management and DRG management

Certifications

Preferred - RN License in state of practice, Certification in Case Management (ACM, CCM, HCQM, CMAC)

Knowledge Skills and Abilities (KSAs)

• Proficiency in using computers, software, and web-based applications and willingness to learn software applications used by the Case Management team.
• Excellent verbal and written communication skills and the ability to present information clearly and professionally to various audience levels.
• Ability to present to leadership groups across the organization to discuss performance and opportunities.
• Excellent interpersonal and conflict management skills, and ability to relate to executive management, physicians, professionals, and business community leaders.
• Excellent collaborator able to build teams that align to strategic purpose.
• Well versed in regulatory & compliance issues and having the ability to learn the local payor rules that influence what we get paid.
• Understands how to review financial performance including: department financial statements, revenue cycle payor denials, and valuing opportunities around proper status levels of patients.

Job Duties

• Oversight for Case Management and Social Services to include: Utilization Management, Discharge Planning, Precertification & Denials Management, Retrospective Medicaid, Medical Necessity Denials and Care Transitions for the organization.
• Develops strategy that drives continuous improvement and sets expectations for teams.
• Sets the overall direction for the assigned areas and implements policies, processes, and procedures throughout the organization.
• Helps strategically set the systems training and development programs to ensure all staff and leaders are understanding of their role and the expectations of performance.
• Collaborates with other key areas of the organization to ensure alignment of goals and performance reviews. Areas to include Physician Advisors, Emergency Medicine, Hospital Medicine, Nursing, Compliance, Revenue Cycle, Finance, Post-Acute Care and Other Medical Specialties.
• Oversees strategy for leadership development and staff retention to ensure we have opportunities to promote from within the team and the staff are actively engaged in achieving department goals.
• Prepares annual strategy for Case Management and sets goals that will be reviewed in monthly operating reviews.
• Ensures we are achieving regulatory compliance within the set standards and the department is working on continuous improvement goals while maintaining a collaborative relationship with the medical staff.
• Ensures that Case Management teams are following a patient centered approach to care and that all areas are focused on meeting patient experience goals where they have influence.
• Adapts behavior to the specific patient population, including but not limited to respect for privacy, method of introduction to the patient, adapting explanation of services or procedures to be performed, requesting permissions and communication style.
• Performs other related duties as assigned.

The above statements describe the general nature and level of work only. They are not an exhaustive list of all required responsibilities, duties, and skills. Other duties may be added, or this description amended at any time.

Remains knowledgeable on current federal, state, and local laws, accreditation standards or regulatory agency requirements that apply to the assigned area of responsibility and ensures compliance with all such laws, regulations, and standards.

This employer maintains and complies with its Compliance & Privacy Program and Standards of Conduct, including the immediate reporting of any known or suspected unethical or questionable behaviors or conduct; patient/employee safety, patient privacy, and/or other compliance-related concerns. The employer is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status.

Physical and Environmental Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Sedentary Work - Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.

Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid.

The incumbent has no occupational risk for exposure to communicable diseases.

Because the incumbent works within a healthcare setting, there may be occupational risk for exposure to hazardous medications or hazardous waste within the environment through receipt, transport, storage, preparation, dispensing, administration, cleaning and/or disposal of contaminated waste. The risk level of exposure may increase depending on the essential job duties of the role.

Ochsner is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to any legally protected class, including protected veterans and individuals with disabilities.