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CORE JOB SUMMARY
 

The Assoc. VP, Care Coordination provides strategic leadership and oversight of care coordination, case management, social services, and utilization management across all services lines within the University of Miami Health System (UHealth). This role is responsible for developing and executing a comprehensive, integrated care coordination strategy that spans both inpatient and outpatient settings, ensuring high-quality, cost-effective care for all patients. In collaboration with senior leadership, the Assoc. VP, Care Coordination will drive the standardization of clinical and social service operations, optimizing exceptional patient outcomes and operational efficiency. This position is accountable for fiscal management, profitability, budget oversight, regulatory compliance, and continuous improvement of care processes. This position will lead the development and implementation of policies and procedures that enhance resource utilization, deliver best-in-class care coordination and social services, and foster a culture of continuous improvement, innovation, and excellence in patient care across UHealth.

CORE JOB FUNCTIONS                                                                                           

Plans, organizes, develops, and directs the overall operational system for care coordination and social services, ensuring alignment with the organization’s strategic objectives including but not limited to intake, discharge planning, case management, utilization review, resource management, care navigation, and patient placement in the appropriate level of care, in accordance with current federal, state, and local laws and applicable regulations.

Collaborates with department leadership to develop short-term and long-term objectives that standardize care coordination activities across inpatient and outpatient units, driving clinical, operational, and financial outcomes.

Oversees the development and execution of care coordination policies, processes, goals, and KPIs aligned to the organization’s strategic plan, utilizing data analysis to identify trends and improve quality, cost-effectiveness, and patient outcomes.

Monitors, evaluates, and develops strategies for practice standards, including facilities, technology, and system process improvements that increase productivity, efficiency, satisfaction and cost savings.

Works closely with health system leadership, including physicians, nursing, allied health, finance, and hospital and satellite administrators, to integrate clinical, financial, and operational goals across UHealth, ensuring optimized care coordination, utilization management, and resource allocation.

Oversees utilization management processes, including denial prevention and management activities, ensuring compliance with federal, state, and local regulations and improving patient flow, medical necessity reviews, and reduction of denials.

Utilizes data to analyze and monitor level of care and length of stay management, physician utilization relative to national and individual hospital standards, and care effectiveness, while ensuring compliance with regulatory standards.

Facilitates communication between managed care organizations and the hospital regarding benefit coverage issues, utilization review, and quality assurance processes. 

Identifies trends in patient treatment, proactively develops programs, and works closely with a variety of constituents including hospital leadership, medical and nursing staff, denial auditors, and utilization review to improve patient health, wellness, and organizational performance.

Determines appropriate staffing for care coordination functions and advises site leaders on staffing needs based on service line expansions or organizational growth.

Works with the revenue cycle department to ensure denial prevention and to analyze causes of denials, while assisting with denials management and ensuring financial sustainability.

Directs the development of operational budgets, analyzes financial performance, and consults with senior leadership on projected organizational plans and financial needs, to identify opportunities for cost savings and resource optimization.

Oversees detailed research into federal and state funding sources for care coordination services and supervises the preparation of grant proposals for funds to support new and improved services.

Collaborates with social services teams to ensure that care coordination activities address social determinants of health, including discharge planning, placement, and community resources for patients.

Ensures compliance with all relevant healthcare regulations, including state and federal guidelines, accreditation standards, and University policies, while maintaining effective internal controls to safeguard organizational assets, ensure operational efficiency, and maintain regulatory compliance and reliability of internal and external reporting.

Remains up to date on ongoing regulatory changes, managed care/hospital contract updates, latest evidence-based care guidelines and outcomes, and professional and social issues in health care.

Ensures that care coordination and social services staff have and maintain appropriate credentials and/or licensure to perform their work, are trained on operational controls, and comply with University policies and procedures.

This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.

CORE QUALIFICATIONS                                                                                        

Education:

Master’s degree in Social Work, Nursing or other relevant field.

Certification and Licensing:

Valid State of Florida Registered Nurse license or Florida Licensed Clinical Social Worker

Experience:

Minimum 7 years of relevant experience

Knowledge, Skills and Attitudes:

Knowledge of business and management principles.

Ability to direct, manage, implement, and evaluate department operations.

Ability to establish department goals, and objectives that support the strategic plan.

Ability to effectively plan, delegate and/or supervise the work of others.

Ability to lead, motivate, develop and train others.

Ability to manage a budget and work within the constraints of that budget.

Ability to recognize, analyze, and solve a variety of problems.

Ability to communicate effectively in both oral and written form.

Ability to maintain effective interpersonal relationships.

The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.

UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for.

The University of Miami is an Equal Opportunity Employer - Females/Minorities/Protected Veterans/Individuals with Disabilities are encouraged to apply. Applicants and employees are protected from discrimination based on certain categories protected by Federal law. Click here for additional information.

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