MHN Associate Vice President of Care Management

Marshall Health Network•Huntington, WV

About The Position

Marshall Health Network is seeking an experienced healthcare leader to provide strategic and operational leadership for care management services across the health system. Reporting to the Chief Nursing Officer, the Associate Vice President focuses on improving patient outcomes, care coordination, operational efficiency, financial performance, and patient experience. The role oversees care management programs and partners with executive leadership, physicians, nursing, social work, quality, finance, and Revenue Cycle teams to strengthen utilization management, improve patient throughput, support value-based care, ensure regulatory compliance, and reduce preventable medical necessity denials. The AVP develops the health system’s strategic vision for care management across inpatient, outpatient, ambulatory, post-acute, and community settings. The position oversees case management, social work, utilization management, care coordination, transitions of care, complex care management, readmission reduction, and related initiatives. The AVP also standardizes workflows, develops staffing models, leads performance improvement and transformation initiatives, and supports effective discharge planning and transitions of care. The role establishes metrics and dashboards, monitors care quality and operational outcomes, manages departmental operating and capital budgets, and supports reimbursement and financial performance. The AVP ensures compliance with applicable regulations and accreditation standards, leads and develops care management leaders, and builds partnerships with internal stakeholders, post-acute providers, community agencies, and payers. The position is primarily office- and hospital-based, with regular travel among health system facilities. Executive on-call responsibilities apply as assigned; occasional evening and weekend meetings may be required.

Requirements

Master’s degree in Nursing, Healthcare Administration, Business Administration, Public Health, Social Work, or a related field.
At least 10 years of progressive healthcare leadership and clinical experience.
At least five years of senior leadership experience overseeing care management services at one or more facilities or across a health system.
Demonstrated experience leading large, multidisciplinary teams.
Experience with value-based care, population health, and healthcare transformation initiatives.
Extensive knowledge of care management, utilization management, case management, and population health.
Strong understanding of CMS regulations, managed care, value-based reimbursement, medical necessity criteria, and payer requirements.
Demonstrated strategic planning, change leadership, financial management, communication, and relationship-building skills.
Ability to use data and performance measures to guide decisions and achieve measurable results.
Proficiency with Microsoft Office applications, particularly Excel.

Nice To Haves

Doctoral degree, such as a DNP, PhD, DHA, or EdD.
Current clinical license, such as RN, LMSW, LCSW, or equivalent.
Relevant certification, such as CRCR, ACM, CCM, CMAC, or Lean Six Sigma.
Experience with electronic health record platforms such as Epic or Cerner, and analytics tools such as Power BI or SQL.
Knowledge of medical coding standards, including ICD-10 and CPT.

Responsibilities

Develop and implement the health system’s strategic vision for care management across inpatient, outpatient, ambulatory, post-acute, and community settings.
Oversee case management, social work, utilization management, care coordination, transitions of care, complex care management, readmission reduction, and related initiatives.
Standardize workflows and best practices across hospitals and ambulatory settings.
Establish appropriate staffing models and promote efficient patient throughput, discharge planning, and transitions of care.
Lead enterprise-wide care management transformation and performance improvement initiatives.
Partner with Revenue Cycle leadership to strengthen medical necessity compliance, improve utilization management, and reduce preventable payer denials.
Establish performance metrics and dashboards to evaluate care management effectiveness.
Monitor and improve length of stay, avoidable readmissions, observation management, patient throughput, patient satisfaction, care transitions, and preventable medical necessity denials.
Lead initiatives to improve clinical outcomes, patient-centered care, and regulatory compliance.
Develop and manage departmental operating and capital budgets.
Identify opportunities to improve financial performance through effective resource utilization.
Support Revenue Cycle and Revenue Integrity initiatives that strengthen reimbursement and reduce avoidable denials.
Optimize performance under value-based payment arrangements, bundled payments, Accountable Care Organizations, and risk-based contracts.
Ensure compliance with applicable federal and state regulations and accreditation standards, including CMS, The Joint Commission, NCQA, and state licensing agencies.
Maintain compliance with utilization review and discharge planning requirements and promote ongoing regulatory readiness.
Recruit, mentor, and develop care management leaders while promoting employee engagement, accountability, and continuous improvement.
Collaborate with executive, physician, and nursing leadership, Finance, Population Health, Quality and Patient Safety, Information Technology, and Revenue Cycle teams.
Build effective partnerships with post-acute providers, community agencies, and payers to support coordinated care and improved outcomes.
Participate in executive on-call responsibilities as assigned.
Attend occasional evening and weekend meetings as required.