VP - Case Management

ochsner; New Orleans (LA); On-site; USD 120,000 - 170,000; Full time

Job summary

Ochsner Health System seeks a senior leader to oversee Case Management and Social Services, directing strategy, operations, and performance in a patient-centered care environment. The role requires a Master’s degree in healthcare or related field and 15 years in case management, with progressive leadership experience and familiarity with payor rules and regulatory compliance.

RN license and CM certifications preferred.

Qualifications

• Master’s degree required in healthcare-related field (business, nursing, or equivalent).
• 15+ years of experience in Case Management or related field with progressive leadership responsibilities.
• Preferred RN license and Case Management certifications (e.g., ACM, CCM, HCQM, CMAC).

Responsibilities

• Oversee Case Management and Social Services; Utilization Management, Discharge Planning, Precertification & Denials Management.
• Develop and implement strategy for continuous improvement and set performance expectations.
• Lead policy implementation and staff development across the organization; align with other clinical and business functions.
• Collaborate with physician leaders, nursing, finance, revenue cycle, and post-acute care for performance review and goals.
• Ensure regulatory compliance and a patient-centered approach to care.

Skills

Leadership

Communication

Presentation to leadership

Interpersonal skills

Collaboration

Regulatory compliance

Financial performance review

Education

Master's Degree in business, nursing, or other 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 leve