Assistant Vice President - Case and Utilization Management | Healthcare System | Southeastern US

Exclusive Search | Competitive Compensation | Professional Challenge | Engaged & Supportive C-Suite Team | Superb Benefits | Comprehensive Relocation Package to Include Temporary Housing

Southeastern, US

• Reports to the Vice President of Revenue Cycle
• Oversees the provision of clinical case management, discharge planning, utilization management, clinical authorizations, and appeals for all age groups within the hospital system
• Collaborates with hospital and corporate office leadership, Case Management leadership, Medical Staff, and Administration to attain system/facility goals for the length of stay (LOS) and resource utilization while maintaining optimal patient outcomes and quality of care
• Manages employee performance and promotes interdepartmental communication and education regarding case management activities and roles
• Educates staff, management, senior leadership, committee members, medical staff, and facility Advisory Boards on any action plans and compliance with CMS and State conditions of participation
• Coordinates strategic care coordination and Case Management initiatives, including reducing readmission rates, facilitating daily patient huddles, managing patient admission clearance processes, and supporting bundled payment initiatives, condition code 44, Physician Advisor program development, Clinical appeals process development, and Observation LOS management
• Develops system-wide initiatives for coordinating Case Management and Discharge Planning, working in conjunction with Community Case Management
• Searches out the best performance and best practices for Utilization Management, Discharge Planning, Inpatient and Observation Clinical Authorizations, and Case Management system-wide, including process development and targeted goals for achieving best practice results
• Works collaboratively with hospital administration, medical staff leadership, department managers, community providers, and all applicable providers to lead initiatives, create training programs, track indicators, and identify opportunities to enhance Utilization Management, Case Management, clinical authorizations, clinical appeals, throughput, and meet KPIs for length of stay, readmissions, inpatient and observation services denial reduction, and Revenue Cycle Services KPIs

• Bachelor's Degree in Nursing with at least 10 years of hospital-based experience as a case manager or MSW is required
• RN preferred
• Accredited Case Manager (ACM) or Certified Case Manager (CCM) certification preferred
• 10 years of supervisory/management experience in a system leadership role
• Experience with Clinical Appeals, Authorizations, and LOS Management
• Knowledge of community healthcare and socioeconomic resources, third-party payer authorization processes, and Joint Commission and CMS Conditions of Participation
• Possesses excellent verbal and written communication skills and interpersonal skills
• Must be self-motivated and self-directed with the ability to problem solve and withstand frequent interruptions in work performance and adapt to changes in workload
• Daily concurrent facility and/or department rounding on staff and stakeholders to gather data and trends, educate improvement throughout the system
• Requires flexibility to work independently and meet/exceed deadlines, often under stressful situations
• Ability to prepare detailed, accurate, and factual reports
• Provide regular reports to staff, management, senior leadership, and various committees, including the facility Advisory Boards, on UR Plan and compliance with all CMS and State conditions of participation
• Demonstrate problem-solving abilities, leadership, conflict management, strategic thinking, and team building skills in order to ensure a productive work environment and achievement of goals
• Ability to establish and maintain effective working relationships with all levels of hospital staff

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