Education

• 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

Experience:

• 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.