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Registered Nurse, AVP, Case Management (AVPCM)

Job Title:

Registered Nurse, AVP, Case Management (AVPCM)

Location:

Norman, OK

Industry:

Healthcare

Job Description:

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 hospital system. 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 hospital system.

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.

·         Direct and supervise case management, social services, and revenue integrity team members.

·         Promote 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.

·         Utilize extensive and creative planning and resource identification to enhance discharge planning for patients with limited financial and supportive resources.

·         Direct the implementation of utilization management and regulatory compliance.

·         Promote evidence based care through physician partnership.

·         Advocate 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.

·         Provide crucial services to children who are suspected victims of child abuse through the Child Protection Team.

Provide consultative leadership, educational development, and support to OUMS facilities regarding resources, regulatory compliance, and financial concerns

·         Assume overall responsibility

·         Demonstrates quality and financial outcomes for the department.

Job Requirements:

Education: Master’s Degree in Nursing OR Social Work

Experience: 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

Licensure/Certifications/Registrations Required: Current license with the Oklahoma State Board of Nursing; Certification in Case Management (ACM, CCM, HCQM, CMAC) or becomes certified within 18 months of employment

Knowledge, Skills and Abilities:

Excellent customer service, collaborative interpersonal and communication skills, with the ability to obtain and foster positive relationships within hospital; 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 hospital 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.

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