Associate Vice President, Care Management

Marshall Health Network, Inc.

Position Summary

Marshall Health Network is seeking an experienced healthcare leader to serve as Associate Vice President (AVP) of Care Management. Reporting to the Chief Nursing Officer, this executive provides strategic and operational leadership for care management services across the health system, with a focus on improving patient outcomes, care coordination, operational efficiency, financial performance, and patient experience.

The AVP oversees care management programs and partners with executive leadership, physicians, nursing, social work, quality, finance, and Revenue Cycle teams to strengthen utilization management, improve patient throughput, support value-based care, ensure regulatory compliance, and reduce preventable medical necessity denials.

Essential Functions and Responsibilities

Strategic and Operational Leadership

• Develop and implement the health system's strategic vision for care management across inpatient, outpatient, ambulatory, post-acute, and community settings.
• Provide oversight of case management, social work, utilization management, care coordination, transitions of care, complex care management, readmission reduction, and related initiatives.
• Standardize workflows and best practices across hospitals and ambulatory settings.
• Establish appropriate staffing models and promote efficient patient throughput, discharge planning, and transitions of care.
• Lead enterprise-wide care management transformation and performance improvement initiatives.
• Partner with Revenue Cycle leadership to strengthen medical necessity compliance, improve utilization management, and reduce preventable payer denials.

Clinical Quality and Outcomes

• Establish performance metrics and dashboards to evaluate care management effectiveness.
• Monitor and improve length of stay, avoidable readmissions, observation management, patient throughput, patient satisfaction, care transitions, and preventable medical necessity denials.
• Lead initiatives that improve clinical outcomes, patient-centered care, and regulatory compliance.

Financial Stewardship

• Develop and manage departmental operating and capital budgets.
• Identify opportunities to improve financial performance through effective resource utilization.
• Support Revenue Cycle and Revenue Integrity initiatives that strengthen reimbursement and reduce avoidable denials.
• Optimize performance under value-based payment arrangements, bundled payments, Accountable Care Organizations (ACOs), and risk-based contracts.

Regulatory Compliance

• Ensure compliance with applicable federal and state regulations and accreditation standards, including those established by the Centers for Medicare & Medicaid Services (CMS), The Joint Commission, the National Committee for Quality Assurance (NCQA), and state licensing agencies.
• Maintain compliance with utilization review and discharge planning requirements and promote ongoing regulatory readiness.

Leadership and Collaboration

• Recruit, mentor, and develop care management leaders while promoting employee engagement, accountability, and continuous improvement.
• Collaborate with executive, physician, and nursing leadership, Finance, Population Health, Quality and Patient Safety, Information Technology, and Revenue Cycle teams.
• Build effective partnerships with post-acute providers, community agencies, and payers to support coordinated care and improved outcomes.

Key Performance Indicators

Performance measures include:

• Length of stay and avoidable days.
• Readmission rates and observation-to-inpatient conversion.
• Preventable denial rates and reimbursement performance.
• Patient throughput, satisfaction, and care transition effectiveness.
• Care management productivity and value-based care performance.
• Discharge before noon.
• Employee engagement and budget performance.
• Regulatory readiness and compliance.

Requirements

• Master's degree in Nursing, Healthcare Administration, Business Administration, Public Health, Social Work, or a related field.
• At least 10 years of progressive healthcare leadership and clinical experience.
• At least five years of senior leadership experience overseeing care management services at one or more facilities or across a health system.
• Demonstrated experience leading large, multidisciplinary teams.
• Experience with value-based care, population health, and healthcare transformation initiatives.
• Extensive knowledge of care management, utilization management, case management, and population health.
• Strong understanding of CMS regulations, managed care, value-based reimbursement, medical necessity criteria, and payer requirements.
• Demonstrated strategic planning, change leadership, financial management, communication, and relationship-building skills.
• Ability to use data and performance measures to guide decisions and achieve measurable results.
• Proficiency with Microsoft Office applications, particularly Excel.

Preferred Qualifications

• Doctoral degree, such as a DNP, PhD, DHA, or EdD.
• Current clinical license, such as RN, LMSW, LCSW, or equivalent.
• Relevant certification, such as CRCR, ACM, CCM, CMAC, or Lean Six Sigma.
• Experience with electronic health record platforms, such as Epic or Cerner, and analytics tools such as Power BI or SQL.
• Knowledge of medical coding standards, including ICD-10 and CPT.

Leadership Competencies

Strategic vision, executive presence, results orientation, financial stewardship, collaboration, innovation, emotional intelligence, change leadership, talent development, patient-centered focus, accountability, and operational excellence.

Working Conditions

• Primarily office- and hospital-based, with regular travel among health system facilities.
• Participation in executive on-call responsibilities as assigned.
• Occasional evening and weekend meetings may be required.