Multi-site Vice President of Case Management and Utilization Career Opportunity in South East Location.
Drives transformational leadership across healthcare Case Management (CM) and Utilization Management (UM) service lines, elevating performance and system‑wide outcomes.
Champions the mission and vision of CM and UM while forging powerful strategic partnerships that enhance care coordination and create seamless care transitions for patients.
Oversees and optimizes daily operations, ensuring exceptional execution of care coordination and utilization review through smart, system‑wide resource alignment.
Builds true systemness by uniting teams around shared best practices, innovative solutions, and proven models that strengthen organizational consistency and quality.
Designs, implements, and scales advanced CM tools that drive efficiency, improve decision‑making, and support exceptional patient care across the entire organization.
Inspires and develops CM and UM Directors, guiding them to achieve ambitious strategic goals and advance key initiatives that move the organization forward.
EXPERIENCE QUALIFICATIONS
EPIC experience required.
5+ years of experience in case management leadership within a large multi-hospital system.
10+ years of overall case management experience
EDUCATION QUALIFICATIONS
Bachelor’s Degree in Nursing required
Master’s Degree in Nursing, Healthcare Administration, or Case Management preferred
LICENSES AND CERTIFICATIONS
Minimum Required: Registered Nurse
Preferred: ACM (Accredited Case Manager) through ACMA, CCM (Certified Case Manager) through CCMC; Board certification in Nursing Case Management (RN-BC) through ANCC.
GENERAL DUTIES
Service Line Operational Leadership
Provide direct leadership, oversight, and accountability for the operational effectiveness of Case Management and Utilization Management at the facility and corporate level.
Execute the Case Management and Utilization Management strategic plan.
Ensure standardization and organizational alignment across healthcare facilities.
Develop a culture of high performance and continuous improvement that values learning and a commitment to quality.
Collaborate with facility and corporate leaders to develop strategies to improve outcomes related to length of stay, hospital throughput, and patient experience.
Operational Improvement & Profitability
Identify opportunities to optimize performance, build internal competencies, and create a rigorous approach to case management with a strong focus on accountability and appropriate use or resources.
Adjust case management and utilization management strategies based on business needs.
Manage complex projects, including resource allocation or organizational changes related to optimization or implementation of new initiatives at the facility and corporate level.
Collaborate with Case Management/Utilization Management leadership and the hospital CFOs to develop and implement measurement tools to track operational and financial performance.
Use internal and external benchmarks to drive high-quality outcomes and efficient processes.
Team and Workforce Development
Communicate effectively with a diverse range of stakeholders, including clinicians, administrators, and front-line staff. Build strong relationships and provide direction to Case Management/Utilization Management Directors to ensure standardization and consistency across all facilities.
Collaborate with the Case Management/Utilization Management leaders and CFOs to ensure appropriate skill mix and staffing ratios for social workers, case managers, and utilization managers.
Attract, develop, and retain talent throughout healthcare system to ensure a succession plan.
Consistently assess the learning and development needs of Case Management/Utilization Management. Provide education as needed based on findings.
Regulatory Compliance
Understand regulatory compliance requirements – state and federal regulations.
Accountability for regulatory compliance with discharge planning and utilization review Conditions of Participation.
Accountability for third party payor requirements related to utilization review practices.
Develop and implement service line policies and operational standards in accordance with the state and federal regulations. Reassess and update as needed.
Ensure compliance with internal policies and operational standards.
SKILLS AND ABILITIES
Strong direct clinical experience and clinical acumen.
Knowledge and experience in utilization review and management.
Complex decision-making skills.
Strong interpersonal communication skills.
Ability to interact within a health system as well as external vendors.
Demonstrated leadership ability.
Influential and supportive of others. Works well with interdisciplinary team members.
Strong analytic skills.
Ability to present material effectively.
Experience in developing and leading governance models for case management and utilization management.
Communicate effectively in a matrix environment.
WORK SHIFT:
Days – 40 hours a week.
Competitive salary range plus relocation assistance.
Qualified candidates send resumes to: tinarobertsrecruiter@yahoo.com
Tina Roberts
Executive & Management Recruitment Services
(415) 770-1200 text/call
(415) 685-6289
I, Tina Roberts employ hospital nurse managers. I, Tina Roberts recruit hospital nurse managers. I place, employ, recruit, locate jobs for healthcare executives and nurse managers. I am the premier provider for employing, recruiting, placing, locating hospital nurse managers and executives with over 25 years of experience and 40 network partners that help get the job done! Contact Tina Roberts about your hospital nurse manager and executive employment needs 415-770-1200.
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