AVP - Case Management

New Orleans, LA, United States

We've made a lot of progress since opening the doors in 1942, but one thing has never changed - our commitment to serve, heal, lead, educate, andinnovate.Webelieve that every award earned, every record broken and every patient helped is because of the dedicated employees who fill our hallways.

At Ochsner, whether you work with patients every day or support those who do, you are making a difference and that matters. Come make a difference at Ochsner Health and discover your future today!

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 d evelops 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.

This employer maintains and complies with its Compliance & Privacy Program and Standards of Conduct, including the immediate reporting of any known or suspected unethical or questionable behaviors or conduct; patient/employee safety, patient privacy, and/or other compliance-related concerns.

The employer is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status.

Physical and Environmental Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Light Work - Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly (Constantly: activity or condition exists 2/3 or more of the time) to move objects. Physical demand requirements are in excess of those for Sedentary Work. Even though the weight lifted may be only a negligible amount, a job should be rated Light Work: (1) when it requires walking or standing to a significant degree; or (2) when it requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or (3) when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible. NOTE: The constant stress and strain of maintaining a production rate pace, especially in an industrial setting, can be and is physically demanding of a worker even though the amount of force exerted is negligible.

Because the incumbent works within a healthcare setting, there may be occupational risk for exposure to hazardous medications or hazardous waste within the environment through receipt, transport, storage, preparation, dispensing, administration, cleaning and/or disposal of contaminated waste. The risk level of exposure may increase depending on the essential job duties of the role.

Are you ready to make a difference? Apply Today!

Ochsner Health does not consider an individual an applicant until they have formally applied to the open position on this careers website.

Individuals who reside in and will work from the following areas are not eligible for remote work position : Colorado, California, Washington, and New York.

Ochsner Health endeavors to make our site accessible to all users. If you would like to contact us regarding the accessibility of our website, or if you need an accommodation to complete the application process, please contact our HR Employee Solution Center at 504-842-4748 (select option 1) or . This contact information is for accommodation requests only and cannot be used to inquire about the status of applications.

We are proud to be an Equal Employment Opportunity and Affirmative Action employer. We are committed to the principles of equal employment opportunity and providing a workplace that is free from discrimination based on race, color, creed, religion, pregnancy status, pregnancy-related conditions, national origin, ancestry, mental or physical disability, medical condition, age, veteran status, military status, citizenship status, marital status, familial status, sexual orientation, gender, gender identity or expression, genetic information, political affiliation, unemployment status, or any other characteristic protected under applicable federal, state or local law. These protections extend to applicants and all employment related decisions. View the EEO is the Law poster and its supplement , as well as the pay transparency policy for more information.

We've made a lot of progress since opening the doors in 1942, but one thing has never changed - our commitment to serve, heal, lead, educate, andinnovate.Webelieve that every award earned, every record broken and every patient helped is because of the dedicated employees who fill our hallways.

At Ochsner, whether you work with patients every day or support those who do, you are making a difference and that matters. Come make a difference at Ochsner Health and discover your future today!

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 d evelops 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.

This employer maintains and complies with its Compliance & Privacy Program and Standards of Conduct, including the immediate reporting of any known or suspected unethical or questionable behaviors or conduct; patient/employee safety, patient privacy, and/or other compliance-related concerns.

The employer is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status.

Physical and Environmental Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Light Work - Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly (Constantly: activity or condition exists 2/3 or more of the time) to move objects. Physical demand requirements are in excess of those for Sedentary Work. Even though the weight lifted may be only a negligible amount, a job should be rated Light Work: (1) when it requires walking or standing to a significant degree; or (2) when it requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or (3) when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible. NOTE: The constant stress and strain of maintaining a production rate pace, especially in an industrial setting, can be and is physically demanding of a worker even though the amount of force exerted is negligible.

Because the incumbent works within a healthcare setting, there may be occupational risk for exposure to hazardous medications or hazardous waste within the environment through receipt, transport, storage, preparation, dispensing, administration, cleaning and/or disposal of contaminated waste. The risk level of exposure may increase depending on the essential job duties of the role.

Are you ready to make a difference? Apply Today!

Ochsner Health does not consider an individual an applicant until they have formally applied to the open position on this careers website.

Individuals who reside in and will work from the following areas are not eligible for remote work position : Colorado, California, Washington, and New York.

Ochsner Health endeavors to make our site accessible to all users. If you would like to contact us regarding the accessibility of our website, or if you need an accommodation to complete the application process, please contact our HR Employee Solution Center at 504-842-4748 (select option 1) or . This contact information is for accommodation requests only and cannot be used to inquire about the status of applications.

We are proud to be an Equal Employment Opportunity and Affirmative Action employer. We are committed to the principles of equal employment opportunity and providing a workplace that is free from discrimination based on race, color, creed, religion, pregnancy status, pregnancy-related conditions, national origin, ancestry, mental or physical disability, medical condition, age, veteran status, military status, citizenship status, marital status, familial status, sexual orientation, gender, gender identity or expression, genetic information, political affiliation, unemployment status, or any other characteristic protected under applicable federal, state or local law. These protections extend to applicants and all employment related decisions. View the EEO is the Law poster and its supplement , as well as the pay transparency policy for more information.

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