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Vp Case Resolution Specialist Jobs (NOW HIRING)

NutriGreen Tulsa

VP of Operations

Kiefer, OK · On-site

VP of Operations Nutri-Green Professional Services Reports to: Owner / CEO (Visionary) Direct ... This CRA owns cancel prevention, complaint resolution, save rate, and the "Make It Right" system ...

NutriGreen Tulsa

VP of Operations

Kiefer, OK · On-site

VP of Operations Nutri-Green Professional Services Reports to: Owner / CEO (Visionary) Direct ... This CRA owns cancel prevention, complaint resolution, save rate, and the "Make It Right" system ...

Nutri-Green Lawn Care

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NESCO Inc

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$17.50 - $23.50/hr

Vice President Case Management or Assistant Vice President Finance - Case Management Supervises: N/A Location: [Insert Location] Industry Experience Preferred: HCA, Parallon, or LifePoint Health ...

Credit Key

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TaxRise

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Align Credit Union

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The VP Controller is a key financial leader responsible for the oversight, integrity, accuracy, and ... resolution. * Audit, Examination & Compliance Support Serve as a primary financial contact for ...

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Vice President (OBH), Case Management

Brooklyn, NY • On-site

One Brooklyn Health
Health Care and Social Assistance • 5 - 10K employees
Learn more about One Brooklyn Healthexternal

$190K/yr

Full-time

Posted 8 days ago

One Brooklyn Health rating

8.7

Company rating: 8.7 out of 10

Based on 10 frontline employees who took The Breakroom Quiz

Job description

Overview
At One Brooklyn Health (OBH), case management is more than coordinating a patient's discharge - it is the critical link between exceptional hospital care and a patient's ability to recover safely, successfully, and with dignity in the community.
The Vice President of Case Management and Social Work provides enterprise-wide executive leadership for the nursing and social work components of case management, utilization management, discharge planning, care coordination, and transitional care throughout OBH. This executive is responsible for building an integrated, patient-centered care-management model that supports patients and families across the continuum - from admission and acute hospitalization through post-acute care, ambulatory services, and successful transition back into the community.
Serving a diverse population with complex medical, behavioral, socioeconomic, and post-discharge needs, the Vice President ensures that every patient receives the right care, in the right setting, at the right time. The position brings together clinical judgment, social-work expertise, operational discipline, data, and community partnerships to remove barriers to care, improve patient progression, and create safe, equitable, and sustainable transitions.
The Vice President establishes system-wide strategy, professional standards, performance expectations, and accountability for case-management services that directly influence length of stay, avoidable days, readmissions, denials, medical necessity, resource utilization, discharge efficiency, patient experience, health equity, and continuity of care.
Working collaboratively with executive leadership, physicians, nursing, social work, behavioral health, finance, revenue cycle, quality, compliance, ambulatory care, post-acute providers, and community-based organizations, Vice President leads process-improvement and optimization initiatives that advance clinical quality, operational efficiency, regulatory compliance, and organizational sustainability.
This executive serves as a transformational leader and trusted advisor who combines compassion with accountability, translates data into action, develops high-performing interdisciplinary teams, and advances OBH's commitment to accessible, culturally responsive, high-quality care for the communities of Central and Northeast Brooklyn.
Responsibilities
Enterprise Strategy and Executive Leadership
  • Provide enterprise-wide executive leadership for nursing case management, social work, utilization management, discharge planning, care coordination, and transitional-care services across OBH.
  • Develop and execute a unified case-management strategy aligned with OBH's clinical, operational, financial, patient-experience, and health-equity priorities.
  • Establish consistent policies, workflows, performance expectations, and escalation processes across all campuses and care settings.

Patient Progression and Care Coordination
  • Lead an integrated patient-progression model that begins at admission and continues through hospitalization, discharge, post-acute care, and transition into the community.
  • Ensure timely assessment of patients' clinical, psychosocial, behavioral, financial, functional, and environmental needs and the development of safe, individualized discharge plans.
  • Partner with interdisciplinary leaders to identify and resolve barriers affecting treatment progression, placement, discharge readiness, and continuity of care.

Transitional Care and Continuity Across the Care Continuum
  • Develop transitional-care programs for patients at elevated risk for prolonged hospitalization, avoidable utilization, readmission, or unsuccessful discharge.
  • Strengthen coordination with ambulatory services, home-care agencies, skilled-nursing facilities, rehabilitation programs, behavioral-health providers, managed-care organizations, and community partners.
  • Ensure effective post-discharge handoffs, follow-up, patient education, and connection to medical, behavioral-health, and community-based services.

Utilization Management and Resource Stewardship
  • Oversee admission-status review, continued-stay review, medical-necessity determinations, payer authorizations, denials, appeals, and peer-to-peer review processes.
  • Partner with physicians, physician advisors, nursing, finance, and revenue cycle to support appropriate utilization, reimbursement, and responsible stewardship of healthcare resources.
  • Lead initiatives to improve length of stay, reduce avoidable days, and address authorization, documentation, placement, and payer-related barriers.

Performance Improvement, Analytics, and Outcomes
  • Establish evidence-based practices, clinical standards, outcome measures, and performance expectations that promote accountability and continuous improvement.
  • Monitor performance related to length of stay, avoidable days, readmissions, denials, discharge efficiency, care transitions, patient experience, quality, caseloads, and departmental productivity.
  • Use data and industry benchmarks to identify performance variation, health disparities, operational risks, and opportunities for improvement, adjusting strategies as organizational needs evolve.
  • Present performance results, risks, and strategic recommendations to executive leadership, medical staff leadership, organizational committees, and the Board of Trustees, as requested.

Workforce Leadership and Professional Practice
  • Develop, and retain a high-performing interdisciplinary leadership team while establishing appropriate staffing models, caseload standards, competencies, and succession plans.
  • Ensure nursing case management and social-work services operate as one coordinated system while maintaining the professional standards, ethical requirements, and scopes of practice of each discipline.
  • Communicate and interpret departmental policies, procedures, performance expectations, and regulatory requirements to leaders and staff.
  • Foster a culture of collaboration, accountability, inclusion, professional development, responsiveness, and service to patients and families.

Physician and Interdisciplinary Partnership
  • Build strong partnerships with physicians, nursing, social work, behavioral health, rehabilitation, revenue cycle, quality, ambulatory care, and other clinical and operational leaders.
  • Establish clear escalation pathways for complex clinical, psychosocial, ethical, financial, and discharge-related cases.
  • Promote shared accountability for patient progression, medical necessity, discharge readiness, and continuity of care.

Regulatory Compliance, Quality, and Risk Management
  • Ensure compliance with applicable Centers for Medicare & Medicaid Services Conditions of Participation, New York State Department of Health requirements, accreditation standards, payer requirements, HIPAA, and organizational policies.
  • Maintain continuous readiness for regulatory surveys, audits, payer reviews, accreditation activities, and other external evaluations.
  • Partner with Quality, Compliance, Legal, Risk Management, and Health Information Management to address documentation, patient-rights, privacy, clinical, and regulatory risks.
  • Ensure protected health information is accessed, used, disclosed, and safeguarded only as necessary to perform authorized responsibilities and in accordance with HIPAA, information-security requirements, and OBH policies.

Financial and Administrative Management:
  • Develop and manage departmental budgets, staffing resources, technology, vendor relationships, and operational investments.
  • Identify opportunities to reduce avoidable utilization, preventable denials, unnecessary discharge delays, and other inefficiencies while maintaining high-quality patient care.
  • Evaluate programs, staffing models, and operational resources based on their impact on patient outcomes, regulatory compliance, efficiency, and financial performance.

Perform other related duties and executive responsibilities as assigned.
#OBH123
Qualifications
Education:
  • Bachelor's degree in Nursing or Social Work from an accredited college or university when required for the candidate's applicable professional license, required.
  • Master's degree in Nursing, Social Work, Healthcare Administration, Public Health, Business Administration, or a closely related field from an accredited college or university. Preferred.

Experience:
  • Minimum of ten (10) years of progressively responsible experience in acute-care case management, social work, utilization management, care coordination, discharge planning, transitional care, population health, or a closely related healthcare function, required.
  • Minimum of five (5) years of senior leadership experience overseeing complex case-management, social-work, utilization-management, or care-coordination operations within a hospital, health system, academic medical center, integrated delivery network, or comparable healthcare organization, required.
  • Demonstrated experience leading nursing and social-work professionals or managing a highly integrated interdisciplinary care-management model, required.
  • Experience developing and implementing system-wide strategies, standardized workflows, evidence-based practices, performance measures, and improvement initiatives across multiple facilities or service lines, required.
  • Experience managing length of stay, avoidable days, readmissions, utilization review, payer denials, discharge barriers, care-transition outcomes, and revenue-cycle considerations, required.
  • Experience managing departmental budgets, staffing plans, performance expectations, and large-scale organizational change, required.
  • Leadership experience within a large, urban safety-net healthcare system, preferred.
  • Experience working in a unionized healthcare environment, preferred.
  • Experience integrating acute-care, behavioral-health, post-acute, ambulatory, long-term-care, and community-based services, preferred.
  • Experience with Medicare, Medicaid, managed care, value-based care, population health, and health-equity initiative, preferred.

Knowledge, Skills and Abilities:
  • Extensive knowledge of acute-care case management, social work, utilization management, discharge planning, patient progression, transitional care, and population-health principles.
  • Strong understanding of the distinct scopes of practice, professional standards, and contributions of nursing and social work within an interdisciplinary case-management model.
  • Thorough knowledge of federal and New York State requirements governing utilization review, discharge planning, patient rights, medical necessity, care transitions, and healthcare reimbursement.
  • Knowledge of CMS Conditions of Participation, New York State Department of Health requirements, accreditation standards, HIPAA, Medicare, Medicaid, managed-care, and payer authorization and appeal processes.
  • Understanding of social drivers of health and their effects on treatment adherence, discharge planning, readmission risk, health equity, and long-term outcomes.
  • Demonstrated ability to lead enterprise transformation and build alignment across multiple hospitals, disciplines, departments, and stakeholder groups.
  • Ability to translate organizational strategy into clear operational standards, measurable objectives, and sustainable workflows.
  • Strong analytical skills and demonstrated ability to use data to evaluate performance, identify trends, support decisions, and drive improvement.
  • Strong financial acumen and understanding of how case management affects revenue integrity, resource utilization, avoidable costs, and organizational performance.
  • Exceptional leadership, communication, negotiation, conflict-resolution, and relationship-management skills.
  • Ability to influence physicians, executives, clinical leaders, payers, post-acute providers, and community partners.
  • Ability to manage complex, sensitive, and high-risk patient situations with sound judgment, discretion, empathy, and professionalism.
  • Demonstrated commitment to health equity, cultural responsiveness, patient dignity, and service to diverse communities.
  • Ability to manage competing priorities and maintain accountability within a complex and rapidly changing healthcare environment.
  • Proficiency with electronic health records, case-management platforms, utilization-management tools, referral-management systems, performance dashboards, and standard business applications.

Licenses, Certifications:
  • Current and unrestricted New York State license as a Registered Professional Nurse, Licensed Master Social Worker, or Licensed Clinical Social Worker, consistent with the candidate's professional discipline, required.
  • Certification in case management, such as Accredited Case Manager, Certified Case Manager, or another nationally recognized case-management certification, preferred.
  • Certification in healthcare quality, utilization management, nursing administration, social-work leadership, or a related specialty preferred.
  • Required professional licenses and certifications must be maintained in good standing throughout employment with OBH.

Physical Requirements:
  • Ability to perform the essential functions of the position with or without reasonable accommodation.
  • Ability to remain in a stationary position and operate a computer and other standard office equipment for extended periods.
  • Ability to communicate effectively in person, by telephone, through virtual platforms, and in writing.
  • Ability to move throughout hospital, ambulatory, post-acute, and administrative environments as necessary.
  • Ability to travel among One Brooklyn Health campuses, facilities, and community-partner locations.
  • Ability to respond to urgent operational, regulatory, or patient-care matters outside regularly scheduled working hours when nece

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