AVP - Case Management
Company: Ochsner Clinic Foundation
Location: New Orleans
Posted on: April 30, 2024
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Job Description:
We've made a lot of progress since opening the doors in 1942,
but one thing has never changed - our commitment to serve, heal,
lead, educate, andinnovate.Webelieve that every award earned, every
record broken and every patient helped is because of the dedicated
employees who fill our hallways. At Ochsner, whether you work with
patients every day or support those who do, you are making a
difference and that matters. Come make a difference at Ochsner
Health and discover your future today! This job provides leadership
and direct oversight for case management and social services
including utilization management, discharge planning,
precertification and denials management, retrospective Medicaid,
medical necessity denials and care transitions for the
organization. Ensures quality of care and patient satisfaction
through oversight of policies, procedures, and improvements. To
perform this job successfully, an individual must be able to
perform each essential duty satisfactorily. The requirements listed
below are representative of the knowledge, skill, and/or ability
required. Reasonable accommodations may be made to enable qualified
individuals with disabilities to perform the essential duties. This
job description is a summary of the primary duties and
responsibilities of the job and position. It is not intended to be
a comprehensive or all-inclusive listing of duties and
responsibilities. Contents are subject to change at the company's
discretion.
Education Required -Bachelor's degree in business, nursing,
education or related healthcare field. Preferred - Master's degree
in business, nursing, education or related healthcare field. Work
Experience
Required -10 years of experience in case management or related
field.
Progressive management experience to include frequent involvement
with senior management, physicians and outside patient care
providers.
Experience with insurance precertification, utilization management
and diagnosis-related group (DRG) management. Certifications
Required -None. Preferred - Current registered nurse (RN) license
in state of practice. Certification in case management (ACM, CCM,
HCQM, CMAC). Knowledge Skills and Abilities (KSAs)
The physical demands described here are representative of those
that must be met by an employee to successfully perform the
essential functions of this job. Reasonable accommodations may be
made to enable individuals with disabilities to perform the
essential functions. Light Work - Exerting up to 20 pounds of force
occasionally, and/or up to 10 pounds of force frequently, and/or a
negligible amount of force constantly (Constantly: activity or
condition exists 2/3 or more of the time) to move objects. Physical
demand requirements are in excess of those for Sedentary Work. Even
though the weight lifted may be only a negligible amount, a job
should be rated Light Work: (1) when it requires walking or
standing to a significant degree; or (2) when it requires sitting
most of the time but entails pushing and/or pulling of arm or leg
controls; and/or (3) when the job requires working at a production
rate pace entailing the constant pushing and/or pulling of
materials even though the weight of those materials is negligible.
NOTE: The constant stress and strain of maintaining a production
rate pace, especially in an industrial setting, can be and is
physically demanding of a worker even though the amount of force
exerted is negligible. Because the incumbent works within a
healthcare setting, there may be occupational risk for exposure to
hazardous medications or hazardous waste within the environment
through receipt, transport, storage, preparation, dispensing,
administration, cleaning and/or disposal of contaminated waste. The
risk level of exposure may increase depending on the essential job
duties of the role. Are you ready to make a difference? Apply
Today! Ochsner Health does not consider an individual an applicant
until they have formally applied to the open position on this
careers website. Individuals who reside in and will work from the
following areas are not eligible for remote work position:
Colorado, California, Washington, and New York. Ochsner Health
endeavors to make our site accessible to all users. If you would
like to contact us regarding the accessibility of our website, or
if you need an accommodation to complete the application process,
please contact our HR Employee Solution Center at 504-842-4748
(select option 1) orcareers@ochsner.org. This contact information
is for accommodation requests only and cannot be used to inquire
about the status of applications. We are proud to be an Equal
Employment Opportunity and Affirmative Action employer. We are
committed to the principles of equal employment opportunity and
providing a workplace that is free from discrimination based on
race, color, creed, religion, pregnancy status, pregnancy-related
conditions, national origin, ancestry, mental or physical
disability, medical condition, age, veteran status, military
status, citizenship status, marital status, familial status, sexual
orientation, gender, gender identity or expression, genetic
information, political affiliation, unemployment status, or any
other characteristic protected under applicable federal, state or
local law. These protections extend to applicants and all
employment related decisions. View theEEO is the Law posterand
itssupplement, as well as thepay transparency policyfor more
information. Affirmative Action Policy Statement We've made a lot
of progress since opening the doors in 1942, but one thing has
never changed - our commitment to serve, heal, lead, educate,
andinnovate.Webelieve that every award earned, every record broken
and every patient helped is because of the dedicated employees who
fill our hallways. At Ochsner, whether you work with patients every
day or support those who do, you are making a difference and that
matters. Come make a difference at Ochsner Health and discover your
future today! This job provides leadership and direct oversight for
case management and social services including utilization
management, discharge planning, precertification and denials
management, retrospective Medicaid, medical necessity denials and
care transitions for the organization. Ensures quality of care and
patient satisfaction through oversight of policies, procedures, and
improvements. To perform this job successfully, an individual must
be able to perform each essential duty satisfactorily. The
requirements listed below are representative of the knowledge,
skill, and/or ability required. Reasonable accommodations may be
made to enable qualified individuals with disabilities to perform
the essential duties. This job description is a summary of the
primary duties and responsibilities of the job and position. It is
not intended to be a comprehensive or all-inclusive listing of
duties and responsibilities. Contents are subject to change at the
company's discretion.
Education Required -Bachelor's degree in business, nursing,
education or related healthcare field. Preferred - Master's degree
in business, nursing, education or related healthcare field. Work
Experience
Required -10 years of experience in case management or related
field.
Progressive management experience to include frequent involvement
with senior management, physicians and outside patient care
providers.
Experience with insurance precertification, utilization management
and diagnosis-related group (DRG) management. Certifications
Required -None. Preferred - Current registered nurse (RN) license
in state of practice. Certification in case management (ACM, CCM,
HCQM, CMAC). Knowledge Skills and Abilities (KSAs)
The physical demands described here are representative of those
that must be met by an employee to successfully perform the
essential functions of this job. Reasonable accommodations may be
made to enable individuals with disabilities to perform the
essential functions. Light Work - Exerting up to 20 pounds of force
occasionally, and/or up to 10 pounds of force frequently, and/or a
negligible amount of force constantly (Constantly: activity or
condition exists 2/3 or more of the time) to move objects. Physical
demand requirements are in excess of those for Sedentary Work. Even
though the weight lifted may be only a negligible amount, a job
should be rated Light Work: (1) when it requires walking or
standing to a significant degree; or (2) when it requires sitting
most of the time but entails pushing and/or pulling of arm or leg
controls; and/or (3) when the job requires working at a production
rate pace entailing the constant pushing and/or pulling of
materials even though the weight of those materials is negligible.
NOTE: The constant stress and strain of maintaining a production
rate pace, especially in an industrial setting, can be and is
physically demanding of a worker even though the amount of force
exerted is negligible. Because the incumbent works within a
healthcare setting, there may be occupational risk for exposure to
hazardous medications or hazardous waste within the environment
through receipt, transport, storage, preparation, dispensing,
administration, cleaning and/or disposal of contaminated waste. The
risk level of exposure may increase depending on the essential job
duties of the role. Are you ready to make a difference? Apply
Today! Ochsner Health does not consider an individual an applicant
until they have formally applied to the open position on this
careers website. Individuals who reside in and will work from the
following areas are not eligible for remote work position:
Colorado, California, Washington, and New York. Ochsner Health
endeavors to make our site accessible to all users. If you would
like to contact us regarding the accessibility of our website, or
if you need an accommodation to complete the application process,
please contact our HR Employee Solution Center at 504-842-4748
(select option 1) orcareers@ochsner.org. This contact information
is for accommodation requests only and cannot be used to inquire
about the status of applications. We are proud to be an Equal
Employment Opportunity and Affirmative Action employer. We are
committed to the principles of equal employment opportunity and
providing a workplace that is free from discrimination based on
race, color, creed, religion, pregnancy status, pregnancy-related
conditions, national origin, ancestry, mental or physical
disability, medical condition, age, veteran status, military
status, citizenship status, marital status, familial status, sexual
orientation, gender, gender identity or expression, genetic
information, political affiliation, unemployment status, or any
other characteristic protected under applicable federal, state or
local law. These protections extend to applicants and all
employment related decisions. View theEEO is the Law posterand
itssupplement, as well as thepay transparency policyfor more
information. Affirmative Action Policy Statement
Keywords: Ochsner Clinic Foundation, Metairie , AVP - Case Management, Executive , New Orleans, Louisiana
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