AVP - Case Management

This job provides leadership and direct oversight for case management and social services including utilization management, discharge planning, precertification and denials management, retrospective Medicaid, medical necessity denials and care transitions for the organization.

Ensures quality of care and patient satisfaction through oversight of policies, procedures, and improvements.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required.

Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential duties.

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 - Bachelor's degree in business, nursing, education or related healthcare field.
• Preferred - Master's degree in business, nursing, education or related healthcare field.

Work Experience :

• Required - 10 years of experience in case management or related field.
• Progressive management experience to include frequent involvement with senior management, physicians and outside patient care providers.
• Experience with insurance precertification, utilization management and diagnosis-related group (DRG) management.

Certifications :

• Required - None
• Preferred - Current registered nurse (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, including Microsoft Office and Case Management Information Systems (CMIS).
• Effective verbal and written communication skills and ability to present information clearly and professionally to varying levels of individuals.
• Working knowledge of statistics and performance improvement tools and techniques.
• Excellent organizational and multitasking skills.
• Excellent interpersonal skills.

Job Duties :

• Sets the overall direction for assigned areas and implements policies, processes, and procedures throughout the organization.
• Supervises case management leaders and all associated personnel and oversees program development, utilization review, discharge planning, documentation assurance and perspective payment system management activities throughout the health system.
• Provides consultative, leadership, educational development, and support services to the acute care facilities and affiliated networks in areas of utilization management, case management, clinical management, and improved operational efficiencies.
• Serves as a content expert for the development of the clinical information system to tie the clinical delivery to the business and operations for the organization.
• Coordinates and manages patient centered care activities for patients within the context of case management.
• Guides the department in achieving its regulatory compliance and continuous improvement goals and maintaining a collaborative relationship with the medical staff to assist with the development of clinical services and the provision of quality patient care.
• Coaches and monitors directors and team members to ensure that the standards and initiatives of patient-centered care is a living reality in their work units / departments while being attentive to the business of healthcare, ensuring proper authorization in partnership with financial leadership.
• Ensures operational profitability through effective budgeting and resource management and develops and executes long-term strategic business plans that support business growth.
• Manages the physical and technological infrastructure and supports organizational structures movement initiatives.
• Performs other related duties as required.

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.

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About Ochsner Health :

Ochsner Health is a system that delivers health to the people of Louisiana, Mississippi and the Gulf South with a mission to Serve, Heal, Lead, Educate and Innovate.

Ochsner Health is a not-for-profit committed to giving back to the communities it serves through preventative screenings, health and wellness resources and partnerships with innovative organizations that share our vision.

Ochsner Health healed more than 876,000 people from across the globe in 2019, providing the latest medical breakthroughs and therapies, including digital medicine for chronic conditions and telehealth specialty services.

Ochsner Health is a national leader, named the top hospital in Louisiana and a top children’s hospital by U.S. News & World Report.

As Louisiana’s leading healthcare educator, Ochsner Health and its partners educate thousands of healthcare professionals annually.

Ochsner Health is innovating healthcare by investing in new technologies and research to make world-class care more accessible, affordable, convenient and effective.

Ochsner's team of more than 26,000 employees and 4,500 providers are working to reinvent the future of health and wellness in the region.

To learn more about Ochsner Health, please visit www.ochsner.org. To transform your health, please visit www.ochsner.org / healthyyou.