Vice President, Care Management
Allegheny Health Network is an integrated delivery network focused on preserving health care choice and providing affordable, high-quality care to the people in our communities. With more than 14,000 employees including 7,400 health care professionals, nearly 200 primary care and specialty care practices, Allegheny Health Network includes seven hospitals in Pennsylvania with nearly 2,400 licensed beds.
Allegheny Health Network’s clinical expertise ranges from primary care to the most complex surgical procedures. Services include cancer diagnosis and treatment, cardiovascular care, neurological and neurosurgical services, organ transplantation, orthopedic and rehabilitation services, and women’s health.
Job Summary: Reporting to the Chief Nurse Executive, the incumbent will be responsible for the strategic development of clinical care management. The position will direct the clinical operations of care management and establish highly reliable business processes and technology systems that produce benchmark results in performance. The incumbent will serve as a role model in leading complex systems and decision processes and customer management that uphold the values, business objectives, and service expectations of the organization.
Responsibilities: The Vice President, Case Management is responsible for leading the development and overseeing the execution of policies and procedures. Directing the standardization of CM policies, practices workflow and data reporting within the system. Maintains quality patient care and adheres to all relevant compliance activities. Accustomed to managing through KPIs and provide education/driving towards improvement. Creates consistency/standard work. Manages people daily through EPIC (core system). Develops trust, cooperation, and collaboration with administrative medical staff and departments across the system.
Establishes strategic, tactical and financial plans to optimize the efficacy of clinical case management operations. Maintains work plans and annual goals with quarterly results reporting systems that demonstrate performance improvement trends.
Leads the development of effective communication with internal and external customers to coordinate and adequately address patient care needs. Collaborates with utilization management and revenue cycle to ensure processes are aligned. Develops utilization targets in collaboration with system physician and nursing leadership. Provides accurate and pertinent information to appropriate departments, administration, medical staff, and others involved with CM activities. Understands compliance from a Case Management perspective.
Reviews data for trends and analyzes the impact on department operations. Leads the implementation of improved clinical care management models utilization management systems to decrease readmissions, recidivism, and excessive length of stay and medical denials; responds to regulatory changes.
Qualifications: Masters Degree in Nursing with seven years of management experience in clinical case management with a nursing background required.
Demonstrated an ability to lead senior-level teams; to coach, mentor and develop staff and guide them to achieve excellent results.
Proven track record in case management and utilization review, and related business planning and performance management.
Ability to build reliable systems leveraging technology and producing concurrent monitors and executive dashboards that motivate and control performance real time across operations.
Thorough understanding of regulatory and accrediting agency requirements and achieve high levels of compliance through the establishment of proactive compliance management systems.