Vice President, Case Management

Med-Metrix•New York, NY

About The Position

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.

Requirements

Bachelor’s Degree in Nursing
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
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
Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes

Nice To Haves

Master’s Degree in Nursing and other health care related courses
Certification in Hospital Management strongly preferred

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