Corporate Director of Care Management

Nexus Health Systems Ltd•Houston, TX

About The Position

Nexus Health Systems is seeking an experienced and strategic healthcare leader to serve as the Corporate Director of Care Management. This role provides operational and clinical oversight for all case management, utilization review, discharge planning, and care coordination functions across multiple Nexus facilities. The Corporate Director will partner closely with executive leadership, physicians, nursing teams, and interdisciplinary departments to drive exceptional patient outcomes, regulatory compliance, patient throughput, and financial performance. This position plays a critical role in supporting patients with neurodevelopmental disorders and co-occurring complex behavioral and medical conditions across the continuum of care.

Requirements

Bachelor of Science in Nursing (BSN) required
Master of Science in Nursing (MSN) required
Minimum 7 years of progressive leadership experience in hospital case management
Multi-site leadership experience required
Strong background in utilization review, discharge planning, and care coordination
Knowledge of CMS regulations, Joint Commission/DNV standards, and utilization management practices
Current and valid Texas Registered Nurse (RN) license required
Case Management Certification required (ACM, CCM, CMGT, FAACM, or equivalent)
Certification must be obtained within two years of hire if not currently held

Nice To Haves

Experience working with neurodevelopmental, behavioral health, and medically complex populations strongly preferred
Expert knowledge of CMS Conditions of Participation and utilization management principles
Proficiency with InterQual® criteria and medical necessity determinations
Strong leadership, communication, and interdisciplinary collaboration skills
Experience with EHR systems and healthcare analytics
Exceptional organizational, strategic planning, and operational management abilities
Compassionate, patient-centered leadership style with strong advocacy skills

Responsibilities

Lead and standardize care management operations across assigned facilities
Oversee utilization review, discharge planning, care coordination, and transition of care processes
Ensure compliance with CMS Conditions of Participation, Joint Commission/DNV standards, and URAC principles
Establish and oversee Utilization Management Committee operations
Collaborate with physician advisors regarding medical necessity determinations and documentation quality
Implement InterQual® criteria for admission status, continued stay reviews, and discharge readiness
Promote Neurodevelopmental Disabilities (NDD)-informed care practices throughout care management workflows
Support interdisciplinary collaboration to improve patient throughput and continuity of care
Monitor regulatory compliance related to utilization review and discharge planning
Lead performance improvement initiatives and accreditation readiness efforts
Conduct audits related to documentation, appeals, timeliness, and care coordination practices
Promote patient safety and continuous quality improvement across facilities
Ensure accurate documentation supporting medical necessity and fiscal reimbursement
Champion person-centered discharge planning and patient advocacy initiatives
Support sensory-friendly environments and communication accommodations for neurodiverse patients
Assist patients and families with community resources, financial assistance, and care transitions
Collaborate with patients, caregivers, and healthcare teams to prevent fragmentation of services
Provide mentorship, coaching, and operational guidance to care management teams
Oversee recruitment, onboarding, and professional development for department staff
Develop competency pathways and leadership development programs
Encourage professional certification attainment including CCM, ACM-RN, ACM-SW, and CPHQ
Facilitate annual education and training related to InterQual®, CMS regulations, and best practices
Optimize length of stay and reduce avoidable days through proactive utilization management
Monitor throughput, payer denials, appeals, case mix, and departmental performance metrics
Develop and manage departmental budgets and resource allocation
Collaborate with payers and physician advisors to support efficient, cost-effective care delivery
Ensure equitable care management services regardless of payer source