Lehigh Valley Health Network

Manager

• Applies expertise to coordinate comprehensive care for a designated patient population across the continuum of care.
• Involves assessing, planning, implementing, and evaluating individualized care plans while ensuring safe and timely discharge planning.
• Serves as a clinician, care manager, and educator, collaborating with the interdisciplinary team to achieve high-quality, cost-effective outcomes.
• Actively manages resources to minimize unnecessary utilization and supports performance improvement initiatives to enhance patient care and system efficiency.

Inpatient Care Manager – MSW

• Manage a team to improve healthcare value and achieve enterprise goals
• Collaborate with internal and external partners for strategic initiatives
• Track project progress and ensure standardized reporting
• Develop operational processes for client delivery satisfaction
• Build and maintain relationships with key stakeholders

Manager, Strategic Implementation

Affiliate Manager

• Collaborates with internal and external business partners to improve healthcare value and enable the achievement of the mission, vision, strategies, network goals, and strategic business objectives.
• Improves the colleague and patient experiences and serves as an innovative, strategic partner and supports the key stakeholders through robust project management skills.
• Co-creates, executes, evaluates, and adjusts short and long-term team and divisional goals, strategies, and vision.
• Cultivates a strengths-based culture of continuous learning, continuous improvement, and delivery of highly reliable, measurable results.
• Designs, plans, delivers, evaluates, and continually supports project management needs on strategic network initiatives to drive healthcare value and achieve enterprise goals.
• Utilizes the portfolio management system and supports the enterprise-wide intake and pipeline development of potential improvement projects.
• Leverages technical skill sets to bridge the needs of key stakeholders.
• Assesses variation, complex organizational performance gaps and strategic expense reduction and revenue growth opportunities.
• Performs root cause and gap analysis based on current state data.
• Defines and forecasts based on trend data.
• Collaborates with clients and business partners to share status, results, and feedback on projects.
• Builds and maintains a professional peer network and membership in relevant professional organizations.
• Leads and balances multiple senior level projects while also mentoring junior team members.
• Recommends and executes aligned, short and long-term departmental and divisional goals, strategies, and vision.

Senior Strategic Implementation Partner

Auditor

• Functions as Hospital Liaison with Third Party billing and auditing firms for all audits for LVHN locations
• Reviews all audits in LVHN audit software and writes appeals for charge and line item audit denials as well as level of care and medical necessity denials
• Communicates audit results and develops action plan to reduce incidence of denials for LVHN
• Provides explanation of hospital charges to inquiring patients
• Participates in revenue recovery/revenue enhancement through the verification of correct charging procedures in EMR
• Provides education to hospital departments to facilitate correct charges on all claims
• Works with Physician Advisors on appeals to payors/third party vendor and documents their follow up in LVHN audit software and EMR
• Collaborates with management team to participate with Insurance providers and third-party audit vendors to resolve audit appeal disputes or issues
• Creates an audit appeal letter to uphold the claim based on our charging practices or medical necessity documentation found in the EMR or coordinates and implements on site audits as required in lieu of a written appeal
• Coordinates audit appeals that need a physician’s input with the payor and sends claims to write off that have no further appeals
• Coordinates downgrade of class as directed by Physician Advisor for audited claims
• Facilitates write off accounts that cannot provide support for line item denials or level of care denials
• Looks for missing charges and investigates charges and usage to be sure correct charges are on the claim
• Identifies areas of incorrect charging practice, provides action plan to correct charging and does follow up auditing for compliance of action plan
• Provides monthly reporting, while working with clinical data support team, for action plans, line item audits and medical necessity audits
• Keeps all assigned work ques current that includes but are not limited to Gift of Life, Life threatening, OBV hours, bed charges
• Ensures compliance with regulatory and accrediting requirements
• Charge corrections and conversion accounts will be worked by this group.
• Will complete special projects as assigned.

Nurse Auditor

Program Manager

• Deploys and directs a team of professionals to support the enterprise in achieving its goals through the implementation of key initiatives and strategic projects.
• Provides direct coaching and feedback to less experienced team members.
• Designs, implements, and upholds the standards and processes for the Strategic implementation partners program (leveraging technology and program templates) in support of the implementation of the key enterprise and strategic initiatives.
• Continually seek for opportunities to improve the customer experience and enhance the effectiveness and efficiencies of the program.
• Collaborate with other stakeholders to align on the enterprise approach with leveraging tools to drive the implementation, management, and reporting of strategic initiatives.
• Builds and develops relationships both internal to the enterprise as well as a professional network including any external consultants/vendors and membership in relevant professional organizations.
• Build and lead high-performing cross-functional teams to execute transformation initiatives effectively.

Vice President, Strategic Implementation – Program Operations

• Oversees operations within practices
• Provides leadership and supervision of practice operations
• Ensures patient access and financial performance
• Monitors trends in patient experience
• Facilitates performance management of all reports

Manager, Physician Practice

Director

• Facilitates and leads daily Value Analysis activities within the Value Analysis team focusing on cost reduction, quality improvement, and supply chain optimization
• Collaborates with clinical and operational teams to evaluate products, services and technologies to ensure they deliver value while maintain high standards of patient care
• Provides leadership, training, and support to colleagues involved in Value Analysis initiatives
• Proactive communication with clinical, operational and supply chain colleagues to ensure cost-effective, high-quality decisions
• Facilitates meeting activities supporting the value analysis committees with stakeholder such as physicians, nurses, and other leaders
• Drives accountability within the value analysis team ensuring deadlines are met
• Builds relationships across the health care continuum to drive change
• Reviews internal value analysis processes and identifies areas for improvement and efficiencies
• Comfortable handling risk and dealing with areas of uncertainty
• Strong knowledge of healthcare with the ability to perform and review clinical research
• Ability to solve day to day problems within value analysis and a healthcare setting
• Exhibits leadership skills and acts as a change agent to support the mission, vision, and values of the Network