Vice President Case ManagementSend to my Email Email a friend Job ID 76793 Date posted 10/19/2016
Requisition ID: 76793
- Facility: Executive Payroll
- City: San Diego
- Department: SHC Clinical Effectiveness
- Category: Executive Jobs
- Job Status: Full-Time
- Shift: Day Job
- FTE: 1.0
- Shift Start: Variable
- Shift End Time: Variable
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Vice President Case Management
Sharp Healthcare System
The VP of Case Management is accountable for strategic planning, development and implementation of the system-wide case management program, setting priorities, building strategic partnerships to improve care coordination and transitions of care across Sharp Healthcare as well as oversight and ongoing development of hospital case management, utilization and Social Work departments.
Responsibilities will include; leading standard work across the system as it relates to case management and social services in the in-patient setting including referrals and authorizations, utilization review, discharge planning, social services, disease and population management programs. In addition to developing quality measurement systems to measure program operations and outcomes across the system, and provide strategic direction and development of the hospital case management leaders.
The VP will develop plans and strategies in compliance with government, commercial and other payer rules per Sharp HealthCare contracts. Manage the centralized clinical appeals function for both government and commercial payer HealthCare contracts to include RAC response and management.
The VP of Case Management will serve as a liaison with the major medical groups to assure quality utilization management systems, discharge planning and physician satisfaction. The role demands multiple skill domains including clinical operations, education, consulting, leadership, technology expertise, performance improvement, and patient safety.
Required Skills and Qualifications
- Must have a minimum of 7 years of progressively more responsible experience in Case Management, Social Work or Utilization Review.
- Minimum of 5 years related management experience.
- Accomplished team-oriented leader with demonstrated achievements in implementing projects in a complex healthcare organizations.
- Must possess strong skills in project management, business and clinical process redesign, written / verbal communication, physician relations, and customer satisfaction.
- Must be a skilled decision-maker that works proactively in a high stress environment.
- Must be proficient with Microsoft operating systems and office tools.
- Master’s degree in Nursing or other healthcare or business related field, including Business Administration or Health Care Administration.
- Masters level education in health related field.
Compensation and Benefits:
The position provides a very competitive compensation, including opportunity to participate in a system-wide incentive program along with a generous benefit package
- Supervises the Case Management leaders across the four acute care and 3 specialty hospitals to drive systematic performance improvement for case management, social work, and utilization management for the Sharp HealthCare System.
- Manages the centralized clinical appeals function that responds to denials from government and commercial payers.
- Partners with Hospital Operations Executives and Medical group leadership to support collaboration within case management function and ensure seamless interfaces across the care continuum.
- Develops plans and strategies for gaining physician and other healthcare providers’ acceptance and understanding of CMS and other payer requirements and optimizes appropriate use of inpatient and outpatient beds, as well as post-acute care services.
- Oversees implementation of new workflow and process strategies designed to reduce length of stay, resource utilization and readmissions.
- Ensures organizational compliance with legislation and regulations such as Title 22, Joint Commission, and CMS regarding case management, discharge planning and utilization review. Also ensures compliance with payer contractual requirements for utilization review and discharge planning as well as optimization of post-acute care services coordination.
- Directs the design and deployment of system specific training programs for Case Management, Social Services and Utilization Review.
- Assists in developing, reviewing, and implementing Case Management policies and procedures including direction in planning relevant case management and utilization review committees as well as the development of the utilization review plans.
- Participates in the system revenue cycle process with oversight of issues related to clinical authorizations, denials and processes to manage them
- Proactively identifies and coordinates clinical change management and workflow transformation projects to optimize effective use of case management and social services departmental resources
- Represents the health system to internal and external customers, including patients and families and health plans.
- Conducts meetings with payers and post-acute providers to develop plans for transitions of care.
- Maintains professional and collaborative relationships with the hospital administration, staff, physicians, service line administration, and other internal and external customers, including health plans, medical groups, patients and families.
- Maintains knowledge of local and national trends in healthcare delivery, legislation and accreditation standards that affect the organization as well as developments in case management as they apply to care coordination, payment methodologies, utilization management and contracting.
- Directs, with the Case Management leaders, the prioritization of system enhancements and system configuration of the Sharp HealthCare’s case management information system (ECIN) and related systems e.g. teletracking, GE centricity.
- Actively participates in professional groups and national meetings to build knowledge of successful case management practices.
About Sharp HealthCare ~
Sharp HealthCare is a not-for-profit integrated regional health care delivery system based in San Diego, California. Sharp includes four acute care hospitals, three specialty hospitals, two affiliated medical groups, a health plan, plus a full spectrum of other facilities and services. Serving a population of approximately 3 million in San Diego County, Sharp has more than 17,000 employees and 2,600 affiliated physicians on medical staffs, and operates 1,867 beds. The Sharp Experience is our unique, system wide commitment to transforming the health care experience in San Diego by becoming the best place to work, practice medicine and receive care.
Since 2001, our team has been on an exciting journey to transform the health care experience. We are passionate about providing health care the way it should be.
With exceptional skill. With advanced technology. And, especially, with kindness and empathy toward our patients and their loved ones. It’s going beyond caring for people to caring about people. This is the extraordinary level of care we call The Sharp Experience.
Encouraging everyone to find their passion and purpose is at the heart of The Sharp Experience. We are focused on providing an innovative and caring environment where employees are valued for the role they play in helping Sharp achieve its vision to be the best place to work, practice medicine and receive care. Become a part of our team and find out what it means to do what you love.
“Sharp HealthCare is proud to be an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, gender identity, transgender status, sexual orientation, protected veteran status or any other protected class.”
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