Vice President Case Management

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The Vice President, Care Management is responsible for setting the strategy for Case Management across Bon Secours Mercy Health. This position leads 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. Develops trust, cooperation, and collaboration with administrative, medical staff and departments across the system.

Mission/Core Values: It is expected that all of the duties and responsibilities of this position will be performed in a manner consistent with the Ministry’s Standards of Behavior (CARE; Compassion: seeks to understand, listen and explain; Advocate: is the voice for the vulnerable; Respect: demonstrates the highest regard for and welcomes all people; Excellence: commits to the highest standard of quality care, joyful service, and teamwork) and in a manner that reflects the core values of Mercy Health which are: Excellence, Human Dignity, Justice, Compassion, Sacredness of Life and Service. All supervisors and above are expected to model the organizational mission and values through their daily actions, decision making and priority setting. All supervisors and above are expected to develop, implement and monitor short and long range plans to meet or surpass standards consistent with the overall strategic plan.

The Vice President, Care Management is responsible for setting the strategy for Case Management across Mercy Health. This position leads the development and overseeing the execution of policies and procedures, concurrent Denials Management efforts and physician advisor coordination. Directing the standardization of CM policies, practices workflow and data reporting within 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. Evaluates the facility’s/practice’s case management/care coordiantion operations as well as individual core processes to improve performance and financial expectations. Removes barriers to optimal performance including: decreasing length of stay, reducing readmissions, ensuring regulatory compliance, reducing denials, enhancing population health management. Utilizes process improvement tools which may include lean six sigma tools, process mapping, kaizens, and industry evidence based practices, etc. to define opportunities for improvement and facilitate the development of the improvement plan.

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.

Collaborates with utilization management and other revenue cycle leaders 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. Ownership of ED utilization/direct admits process coordination. Understands compliance from a Case Management perspective.

Leads the Denials management function for the system. Will be responsible for reporting denial activity with financial implications, identifying current patterns and trends, and providing recommendations to minimize or avert future denials. Will develop proactive denial-prevention strategies that will decrease denials overall, such as contract language, patient-access-process changes, case management collaboration, appeal opportunities, etc.

Mercy Health is an equal opportunity employer.

We’ll also reward your hard work with:

• Great health, dental and vision plans
• Prescription drug coverage
• Flexible spending accounts
• Life insurance w/AD&D
• An employer-matched 403(b) for those who qualify.
• Paid time off
• Tuition reimbursement
• And a lot more

Scheduled Weekly Hours:

40

Work Shift:

Days/Afternoons

Department:

Quality

All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you’d like to view a copy of the affirmative action plan or policy statement for Mercy Health – Youngstown, which is an Affirmative Action and Equal Opportunity Employer, please email recruitment@mercy.com. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at recruitment@mercy.com.

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