Case Management Director
About The Position
We are seeking an experienced Case Management Director to lead and grow our case management function at a physician‑owned specialty cardiac surgical hospital with fewer than 100 beds. This is a highly visible leadership role reporting directly to the CFO and partnering closely with executive leadership and physicians. The ideal candidate brings strong utilization review and denial management expertise, executive‑level communication skills, and a positive, adaptable leadership mindset. This position is open due to internal growth and represents an opportunity to propel an established team forward while navigating regulatory change and increasing organizational sophistication. This role is 5 days onsite in Lubbock Tx.
Requirements
- Proven ability to communicate effectively with executives, including presenting clinical and financial information clearly and persuasively
- Strong data‑driven mindset with experience developing strategy informed by analytics
- Deep experience in utilization review and denial management
- Demonstrated ability to escalate, troubleshoot, and resolve complex issues through collaboration
- High level of emotional intelligence with the ability to work effectively across all organizational levels
- Positive, adaptable attitude with openness to change in a growing organization
Nice To Haves
- Experience working with Cerner
- Proficiency in Microsoft Excel, SharePoint, and Microsoft Teams
- Strong working knowledge of MCG (Milliman) utilization review criteria
Responsibilities
- Provide clinical and financial guidance to executive leadership, including presenting data‑driven insights and recommendations
- Partner closely with the CFO and hospital leadership on utilization review strategy, denial management, and regulatory compliance
- Lead, mentor, and develop a team of three case management professionals
- Oversee utilization review activities using MCG (Milliman) guidelines to support medical necessity and payer compliance
- Drive effective denial prevention and appeals strategies, identifying trends and opportunities for improvement
- Analyze and present utilization, length‑of‑stay, and authorization data to influence operational and financial outcomes
- Serve as an escalation point for complex cases, payer challenges, and cross‑functional issues
- Collaborate across departments and levels of the organization, including nursing leadership, physicians, finance, and revenue cycle
- Adapt processes and strategies in response to regulatory changes and evolving payer requirements
- Foster a positive, collaborative culture aligned with the hospital’s physician‑owned model
Benefits
- The pay range for this position is $130000.00 - $140000.00/yr.
- Will send to me once we set interview
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
