VP - Case Management

About the role

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.

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.

Additional information

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.

Physical and Environmental Demands

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.

Are you ready to make a difference? Apply Today!

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Please refer to the job description to determine whether the position you are interested in is remote or on-site. Individuals who reside in and will work from the following areas are not eligible for remote work position: Colorado, California, Hawaii, Illinois, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New York, Vermont, Washington, and Washington D.C.

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