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About the Role

Provides leadership and direction for Case Management initiatives and clinical priorities, working collaboratively with leadership to define strategy and ensure stakeholder alignment. Responsible for strategic planning and advancing case management functions including utilization management, care coordination, and transition management. Develops and executes operational strategies aligned with regulatory requirements, organizational goals, and efficiency.

Responsibilities

Executive management of Case Management
Oversees Case Management and social work activities to monitor quality of care
Develops and implements strategy and action plans in alignment with the organization’s strategic planning process
Ensures strategies developed and deployed relate 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

Requirements

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
Certification in Hospital Management strongly preferred
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

Skills

Leadership
Strategic planning
Utilization management
Care coordination
Transition management
Performance metrics analysis
Regulatory compliance
Evidence-based practice
Clinical best practices
Interdepartmental collaboration
JCAHO standards
Federal and state regulatory readiness
Policy development and interpretation
HIPAA compliance
Information Security
Microsoft Office Suite
Interpersonal communication
Problem solving
Decision making
Written communication
Verbal communication

Location

Office setting

Work Type

Full-time

Experience Level

Vice President
10 years acute care clinical experience
10 years case management leadership experience

Education Level

Bachelor’s Degree in Nursing
Master’s Degree in Nursing and other health care related courses – Preferred

About the Company

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

Equal Opportunity

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.