AVP Case Management

Company: OU Medicine
Location: Oklahoma City
Posted on: March 18, 2023

Job Description:

The Assistant Vice President of Case Management (AVPCM) provides leadership and direct oversight for Case Management and Social Services to include: Utilization Management, Discharge Planning, Precertification & Denials Management, Retrospective Medicaid, Medical Necessity Denials and Care Transitions for OU Health (OUH). The AVPCM sets the overall direction for assigned areas and implements policies, processes and procedures throughout the organization; provides direct supervision to Directors of Case Management and all associated personnel and is responsible for the program development, Utilization Review, Discharge Planning, Documentation Assurance and Perspective Payment System management activities throughout OUH.Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position. -

• Directs and supervises case management, social services, and revenue integrity team members.
• Promotes quality, cost effective care through management of access-to-care in the Emergency Department, progression of care, barriers to delivery of care, and transition to lower level of care or discharge back to the community.
• Utilizes extensive and creative planning and resource identification to enhance discharge planning for patients with limited financial and supportive resources.
• Directs the implementation of utilization management and regulatory compliance.
• Promotes evidence based care through physician partnership.
• Advocates for patient/family to meet their social and emotional needs as they impinge on their medical condition, treatment, recovery, and safe transition from one care environment to another. -
• Provides crucial services to children who are suspected victims of child abuse through the Child Protection Team.
• Provides consultative leadership, educational development, and support to OUH facilities regarding resources, regulatory compliance, and financial concerns.
• Assumes overall responsibility for Case Management.
• Demonstrates quality and financial outcomes for the department.General Responsibilities:
  • Performs other duties as assignedMinimum Qualifications:Education: Master's Degree in Nursing OR Social WorkExperience: Ten years of nursing experience including eight years of Case Management or similar experience; Five years of progressive management experience to include at least one year with frequent involvement with senior management, physicians and outside patient care providers; Experience with insurance precertification, utilization management and DRG management; License(s)/Certification(s)/Registration(s) Required: Current RN License issued by the Oklahoma State Board of Nursing, or a current multistate compact RN License (eNLC). Certification in Case Management (ACM, CCM, HCQM, CMAC) preferred.Knowledge, Skills and Abilities:Excellent customer service, collaborative interpersonal and communication skills, with the ability to obtain and foster positive relationships within OU Health; Working knowledge of statistics and performance improvement tools and techniques; Excellent management, communication, problem solving, decision-making and critical thinking skills; Proficient with the use of Microsoft Office and applicable Case Management Information Systems (CMIS); Excellent organizational and interpersonal skills including the ability to manage multiple projects and work collaboratively with OUH leaders and team members; Knowledge of the principles and practices of social and psychological casework. Must be knowledgeable about resources available in the community for use by patients, families and the health care team that would facilitate in the recovery of the patient. Requires knowledge of third party payer issues concerning reimbursement and regulatory perimeters. -Current OU Health Employees - Please click HERE to login. OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family. About Us OU Health is the state's only comprehensive academic health system of hospitals, clinics and centers of excellence. With 11,000 employees and more than 1,300 physicians and advanced practice providers, OU Health is home to Oklahoma's largest doctor network with a complete range of specialty care. OU Health serves Oklahoma and the region with the state's only freestanding children's hospital, the only National Cancer Institute-Designated OU Health Stephenson Cancer Center, Oklahoma's flagship hospital, which serves as the state's only Level 1 trauma center and Edmond Medical Center in the heart of the Edmond Community. Becker's Hospital Review named University of Oklahoma Medical Center one of the 100 Great Hospitals in America for 2020. OU Health's oncology program at OU Health Stephenson Cancer Center was named Oklahoma's top facility for cancer care by U.S. News & World Report in its 2020-21 rankings. OU Health also was ranked by U.S. News & World Report as high performing in these specialties: Colon Surgery, COPD and Congestive Heart Failure. OU Health's mission is to lead healthcare in patient care, education and research. Experts in prevention, treatment and cures, our team works to improve lives through innovation in medical care, education and research, while investing in the people, technologies and facilities that will enable us to achieve our goals. We are seeking individuals who have a passion and talent for caring for others. By joining our team, you will provide quality health care to our community through the work you do every day. We provide clinical and non-clinical opportunities to further your career and we invite you to explore our available positions.Equal employment opportunities are provided to all employees and applicants for employment without regard to race, color, religion, gender, national origin, age, disability, sexual orientation, gender identity, genetic information or protected veteran status in accordance with applicable federal laws. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, transfer, leaves of absence, compensation, and training. Reasonable accommodations are made to the known physical and mental limitations of qualified individuals with disabilities.

Keywords: OU Medicine, Oklahoma City , AVP Case Management, Executive , Oklahoma City, Oklahoma