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Vice President, Case Management in Ontario, CA at PRIME HEALTHCARE SERVICES ONTARIO

Date Posted: 2/11/2019

Job Snapshot

  • Employee Type:
  • Location:
    Ontario, CA
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:

Job Description

VP Case Management is responsible for the provision of leadership, direction, oversight, and operations management for the Case Management and Social Work Programs across all lines of business including commercial and government programs for all Prime Healthcare facilities. Work closely with the Chief Medical Officers and Clinical teams to collaborate on Hospital Services, Population Health Services, Utilization Management, Case Management, Disease Management, Health Plan Management as well as Business Intelligence/Analytics, Quality Management, and Regulatory & Compliance. VP Case Management interprets key performance metrics to develop plans, mobilize the work force, and achieve the case management outcomes relative to improved experience of care and appropriate resource utilization. Develops plans and strategy to offset clinical denials working collaboratively with key partners at the hospital level including C  Suite, and Clinical Services [including Utilization Management, Clinical Documentation Improvement, Performance Improvement, Medical Review and Appeals, Business Office operations, Pharmacy Utilization and Provider Integration]. VP Case Management is accountable for the strategic and operational excellence of the case management within Clinical Services including administrative and care cost initiatives, system development and delivery of high quality outcomes, compliance with all State and Federal regulations that affect Case Management activities and executive level reporting and communication as needed.