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.
What Information Do We Collect?
When you visit our website you may provide us with two types of information: personal information you knowingly choose to disclose that is collected on an individual basis and website use information collected on an aggregate basis as you and others browse our website.
Personal Information You Choose to Provide
We may request that you voluntarily supply us with personal information, including your email address, postal address, home or work telephone number and other personal information for such purposes as correspondence, placing an order, requesting an estimate, or participating in online surveys.
If you choose to correspond with us through email, we may retain the content of your email messages together with your email address and our responses. We provide the same protections for these electronic communications that we employ in the maintenance of information received by mail and telephone.
Website Use Information
Similar to other websites, our site may utilize a standard technology called "cookies" (see explanation below, "What Are Cookies?") and web server logs to collect information about how our website is used. Information gathered through cookies and server logs may include the date and time of visits, the pages viewed, time spent at our website, and the sites visited just before and just after ours. This information is collected on an aggregate basis. None of this information is associated with you as an individual.
How Do We Use the Information That You Provide to Us?
Broadly speaking, we use personal information for purposes of administering our business activities, providing service and support and making available other products and services to our customers and prospective customers. Occasionally, we may also use the information we collect to notify you about important changes to our website, new services and special offers we think you will find valuable. The lists used to send you product and service offers are developed and managed under our traditional standards designed to safeguard the security and privacy of all personal information provided by our users. You may at any time to notify us of your desire not to receive these offers.
What Are Cookies?
Cookies are a feature of web browser software that allows web servers to recognize the computer used to access a website. Cookies are small pieces of data that are stored by a user's web browser on the user's hard drive. Cookies can remember what information a user accesses on one web page to simplify subsequent interactions with that website by the same user or to use the information to streamline the user's transactions on related web pages. This makes it easier for a user to move from web page to web page and to complete commercial transactions over the Internet. Cookies should make your online experience easier and more personalized.
How Do We Use Information Collected From Cookies?
We use website browser software tools such as cookies and web server logs to gather information about our website users' browsing activities, in order to constantly improve our website and better serve our users. This information assists us to design and arrange our web pages in the most user-friendly manner and to continually improve our website to better meet the needs of our users and prospective users.
Cookies help us collect important business and technical statistics. The information in the cookies lets us trace the paths followed by users to our website as they move from one page to another. Web server logs allow us to count how many people visit our website and evaluate our website's visitor capacity. We do not use these technologies to capture your individual email address or any personally identifying information about you.
Notice of New Services and Changes
Occasionally, we may use the information we collect to notify you about important changes to our website, new services and special offers we think you will find valuable. As a user of our website, you will be given the opportunity to notify us of your desire not to receive these offers by clicking on a response box when you receive such an offer or by sending us an email request.
How Do We Secure Information Transmissions?
When you send confidential personal information to us on our website, a secure server software which we have licensed encrypts all information you input before it is sent to us. The information is scrambled en route and decoded once it reaches our website.
Other email that you may send to us may not be secure unless we advise you that security measures will be in place prior to your transmitting the information. For that reason, we ask that you do not send confidential information such as Social Security, credit card, or account numbers to us through an unsecured email.
How Do We Protect Your Information?
Information Security -- We utilize encryption/security software to safeguard the confidentiality of personal information we collect from unauthorized access or disclosure and accidental loss, alteration or destruction.
Evaluation of Information Protection Practices -- Periodically, our operations and business practices are reviewed for compliance with organization policies and procedures governing the security, confidentiality and quality of our information.
Employee Access, Training and Expectations -- Our organization values, ethical standards, policies and practices are committed to the protection of user information. In general, our business practices limit employee access to confidential information, and limit the use and disclosure of such information to authorized persons, processes and transactions.
How Can You Access and Correct Your Information?
You may request access to all your personally identifiable information that we collect online and maintain in our database by emailing us using the contact form provided to you within the site structure of our website.
Do We Disclose Information to Outside Parties?
What About Legally Compelled Disclosure of Information?
We may disclose information when legally compelled to do so, in other words, when we, in good faith, believe that the law requires it or for the protection of our legal rights.
Permission to Use of Materials
The right to download and store or output the materials in our website is granted for the user's personal use only, and materials may not be reproduced in any edited form. Any other reproduction, transmission, performance, display or editing of these materials by any means mechanical or electronic without our express written permission is strictly prohibited. Users wishing to obtain permission to reprint or reproduce any materials appearing on this site may contact us directly.
We are grateful for your donation and support of our organization. If you have made an error in making your donation or change your mind about contributing to our organization please contact us. Refunds are returned using the original method of payment. If you made your donation by credit card, your refund will be credited to that same credit card.
Automated Recurring Donation Cancellation
Ongoing support is important to enabling projects to continue their work, so we encourage donors to continue to contribute to projects over time. But if you must cancel your recurring donation, please notify us.