Vice President, Case Management & Utilization Management
Location: Emeryville, California
Type: Full Time
Salary: Pay Range $153.25 - $207.33 hr
4 Year Degree
Internal Number: R-56574
This role supports the system Chief Nurse Officer (SCNO) in providing executive leadership and guidance for critical areas of Care Management (CM) and Utilization Review (UM) within Sutter Health’s acute care hospitals. The Vice President (VP) will implement the care management mission and vision while building strategic partnerships to improve care coordination and transitions of are across Sutter Health’s network, inclusive of all medical foundations, hospitals, Sutter Care at Home (SCAH) and other care delivery partners (e.g., New Market Leaders – President + CMO, medical groups, independent physicians’ associations, and community partnerships.) Manage day-to-day operations of care coordination, including allocating resources as needed across the Markets. Serve as a dyad partner with VP, Utilization Management and 5 Market Leadership Teams. Disseminate successful solutions and best practices across the network that promote personalized health and that create organizational alignment around care management, including continuity of care, clinical outcomes of case management and social services in inpatient and outpatient settings. Effectively deliver comprehensive care management programs to targeted population groups. Develop and deploy case management tools, leveraging best practices developed within the system to deliver measurable improvements in quality, service, safety, and efficiency across the organization for the benefit of Sutter Health patients, caregivers and customers. The VP will provide leadership to the Directors of CM/UM, assisting them with achieving strategic initiatives and goals. This individual will be responsible for the system’s financial performance related to care progression, denial prevention, and efficient patient throughput. Approximately 500 FTEs.
Bachelor’s Degree Nursing Required
Nursing Degree from an accredited School of Nursing; Bachelor’s required
Master’s Degree in Case Management or Healthcare Administration Preferred
Case Management and/or Healthcare Administration
5+ years of experience in Case Management Leadership, within a large multi-hospital system.
10+ years of overall case management experience or equivalent combination of education and/or experience.
Direct clinical experience and demonstrates strong clinical acumen.
Knowledge and experience in utilization review and management.
Complex decision-making within a time frame involving known and uncertain variables.
Excellent interpersonal communication skills.
Ability to interact within an organization as well as with external sources (federal, state, managed care payers, etc).
Demonstrated leadership ability.
Influential and supportive of others (works well with interdisciplinary team members).
Strong analytic skills and the ability to understand and translate complex financial information into operational business plans.
Ability to speak publicly and present material effectively in a wide variety of public and private settings; present at Sutter Health Board.
Experience in developing and leading governance models for Care Coordination and Utilization Management.
Communicates promptly and effectively in a matrix environment (New Markets).
Skills and Knowledge
Healthcare industry: The VP must have a deep understanding of the healthcare industry, including the regulatory environment within CM & UM knowledge, reimbursement models, and emerging trends. This knowledge is essential to ensure that the health system’s CM and UM strategies are aligned with the organization’s goals and objectives.
Information technology: The VP should possess strong knowledge of care management information systems, including data management. They should stay abreast of new developments and emerging technologies that may be applicable to the care management function.
Process Improvement & Lean Daily Management: The VP should have process improvement capabilities to identify opportunities to optimize performance, build internal competencies and create a more rigorous approach to case management throughout the organization, bringing a strong focus on accountability and appropriate utilization of resources.
Change management: The VP should possess strong change management skills, including the ability to lead and manage complex organizational changes related to implementations, and optimizations at both the front-line and corporate levels.
Leadership: The VP should have excellent leadership skills to lead the CM/UM department and collaborate effectively with other departments in the organization. They should have a vision for how the function can support the organization's mission and be able to communicate that vision effectively. They set the tone for a strong culture and employee engagement throughout case management.
Project management: The VP should have strong project management skills to oversee complex projects, including project planning, resource allocation, and risk management.
Interpersonal skills: The VP should be able to communicate effectively with a diverse range of stakeholders, including clinicians, administrators, and vendors. They should be able to listen actively and build strong relationships with key stakeholders. Providing direction to hospital CM Directors to ensure standardization and consistency across divisions.
Collaboration: The VP should be able to collaborate with various internal and external stakeholders. They should work collaboratively with case management leadership (corporate, market, and hospital), and other division and hospital leaders (CFO, CMO, CNO, Quality, Performance Improvement, Ethics, Legal) as a resource and advisor, proactively analyzing data, aligning goals to improve operational, clinical, quality, and patient satisfaction outcomes.
Financial management: The VP should have a good understanding of financial management and budgeting to manage the costs associated with the financial performance of case management and related productivity as well as the impact of denials on the organization
Regulatory compliance: The VP should have a deep understanding of regulatory compliance requirements, such CMS regulations. They must ensure that the organization's CM and UM functions are compliant with these regulations to avoid potential legal and financial consequences.
Sutter Health, Northern California's largest health network with 23 acute care hospitals, more than 5,000 primary care physicians and specialists, home health, occupational health, psychiatric care and more provides comprehensive medical services in more than 100 Northern California communities. Our mission, vision and values lay the foundation for our day-to-day work in doctors’ offices, home health and hospice programs, hospitals, laboratories, research facilities, administrative offices and medical education services. As a unified health care network, we partner to spread innovation, improve access to health care services and put our patients’ needs first—all to achieve the highest levels of quality, access and affordability.