VP - Case Management

Ochsner Clinic Foundation•New Orleans, LA

18d

About The Position

This role provides leadership and direct oversight for Case Management and Social Services, setting direction for assigned areas and developing plans to meet operating performance standards. The VP works collaboratively with clinical and business functions to align organizational goals and regularly review performance. The role leads Case Management to ensure regulatory compliance and a patient-centered approach that supports patient experience goals. The position oversees Utilization Management, Discharge Planning, Precertification and Denials Management, Retrospective Medicaid, Medical Necessity Denials, and Care Transitions. It develops organizational strategy, policies, processes, and procedures; sets annual goals; supports staff training and development; and promotes leadership development and staff retention. The VP maintains knowledge of applicable laws, accreditation standards, and regulatory requirements, and ensures compliance. Other related duties may be assigned. This is a sedentary healthcare-setting role. It involves sitting most of the time, with occasional walking or standing and occasional exertion of up to 10 pounds. Routine duties do not involve exposure to blood, body fluids, or tissue, and the incumbent is not called upon to provide emergency care or first aid. Occupational exposure to hazardous medications or hazardous waste may occur in the healthcare environment, with risk depending on job duties.

Requirements

Master’s degree in business, nursing, or another healthcare-related field.
15 years of experience in Case Management or a related field.
Progressive management experience, including frequent involvement with senior management, physicians, and outside care providers.
Experience with insurance precertification, utilization management, and DRG management.
Proficiency with computers, software, and web-based applications, and willingness to learn applications used by the Case Management team.
Excellent verbal and written communication skills, including the ability to present clearly and professionally to varied audiences and leadership groups.
Excellent interpersonal and conflict-management skills, with the ability to relate to executive management, physicians, professionals, and business community leaders.
Ability to collaborate effectively and build teams aligned to strategic purpose.
Knowledge of regulatory and compliance issues and ability to learn local payor rules that influence reimbursement.
Ability to review financial performance, including department financial statements, revenue-cycle payor denials, and opportunities related to appropriate patient status levels.

Nice To Haves

RN license in the state of practice.
Certification in Case Management (ACM, CCM, HCQM, or CMAC).

Responsibilities

Provide leadership and direct oversight for Case Management and Social Services.
Oversee Utilization Management, Discharge Planning, Precertification and Denials Management, Retrospective Medicaid, Medical Necessity Denials, and Care Transitions.
Set direction for assigned areas and implement organizational policies, processes, and procedures.
Develop strategies that drive continuous improvement and set performance expectations for teams.
Help establish training and development programs so staff and leaders understand their roles and performance expectations.
Collaborate with Physician Advisors, Emergency Medicine, Hospital Medicine, Nursing, Compliance, Revenue Cycle, Finance, Post-Acute Care, and other medical specialties to align goals and performance reviews.
Oversee leadership development and staff-retention strategy, including opportunities for internal promotion and staff engagement.
Prepare an annual Case Management strategy and set goals for review in monthly operating reviews.
Ensure regulatory compliance and continuous improvement while maintaining a collaborative relationship with the medical staff.
Ensure teams use a patient-centered approach and focus on patient experience goals within their influence.
Adapt communication and service delivery to patient populations, including respecting privacy, requesting permissions, and adapting explanations and communication style.
Remain knowledgeable about applicable federal, state, and local laws, accreditation standards, and regulatory requirements, and ensure compliance.
Perform other related duties as assigned.