Director - Case Management

HonorHealth • Mesa, AZ

1d • Onsite

About The Position

The Case Management Director is accountable for assessment, problem identification, budgeting, outcome monitoring and reporting, long-term planning, and evaluation of the operational aspects of the Clinical Resource Management and Social Services departments. The director oversees clinical operations for managed care plan contracts, including utilization management, case management, and social services, and directs staff performance and development as well as new processes and improvements.

The director provides leadership for patient-level clinical and financial case management to support high-quality care coordination, transition planning, and utilization management. The role works closely with the Chief Medical Officer, Case Management Managers/Supervisors, physicians, system departments, health plans, care facilities, agencies, hospitals, and vendors. It uses data to guide decisions about care outcomes, productivity, and staffing, and leads change initiatives. The position is a member of the Nursing Leadership Council.

The role leads the efficient movement of patients through the continuum of care, supporting timely, effective discharges at the lowest cost while maintaining quality, patient and family satisfaction, and payer requirements. It oversees budgets and financial performance, staffing, policies and procedures, regulatory compliance, utilization review, discharge planning, staff development, and continuous process improvement. The director also supports strategic and service-line goals, external community relationships, education, and the development of future programs and services.

Requirements

• Bachelor's degree in Nursing.
• Master's degree in Social Work.
• At least 2 years managing a Case Management Department and leading people, projects, or teams in the case management domain.
• A current Registered Nurse (RN) license, Licensed Master Social Worker (LMSW) license, or Licensed Clinical Social Worker (LCSW) license.

Nice To Haves

• Master's degree in Nursing or another healthcare profession.
• At least 2 years managing a Case Management Department.
• Accredited Case Manager certification.

Responsibilities

• Lead and direct case management practices for care coordination, transition planning, and utilization management across the continuum of care.
• Ensure processes support timely, effective patient discharges while maintaining quality of care, patient and family satisfaction, cost effectiveness, and payer requirements.
• Prepare and justify annual operating and capital budgets; monitor spending, management reports, budget variances, and financial performance; develop cost-containment strategies.
• Establish staffing patterns and scheduling practices for clinical resource management, social work, clinical documentation, and translation/interpreting services.
• Develop and maintain effective relationships with hospital departments, physicians, health plans, care facilities, agencies, other hospitals, vendors, and community partners.
• Monitor services, department productivity, staffing, DRG financial performance, and clinical and financial outcomes; analyze trends and take appropriate action.
• Lead strategic and tactical planning and develop or restructure programs, services, and processes in support of hospital and system goals.
• Oversee utilization management, social services, and case management for managed care plans, ensuring utilization review complies with health plan provisions and local and federal regulations.
• Develop policies and procedures for Clinical Resource Management and Social Services and establish utilization metrics and goals with the Chief Medical Officer and executive staff.
• Monitor implementation and achievement of utilization goals and action plans; evaluate systems for quality, cost effectiveness, and alignment with managed care objectives.
• Educate staff on current Medicare and AHCCCS rules and regulations and support required regulatory education.
• Direct, manage, and evaluate personnel with Case Management Managers/Supervisors; oversee recruitment, retention, hiring, orientation, and ongoing competency evaluation.
• Promote interdisciplinary teamwork, collaboration, staff accountability, and a culture of development and learning.
• Serve as clinical liaison for managed care contracts and Medicare, and partner with medical staff to support appropriate resource utilization for hospitalized patients.
• Round with the Chief Medical Officer to identify improvement opportunities in Clinical Resource Management and bed utilization.
• Report Clinical Resource Management and Social Services outcome indicators to the Utilization Management Committee and Administration.
• Facilitate educational opportunities for staff and students and foster relationships with educational and external professional organizations.
• Participate in continuing education and quality improvement activities, and support professional membership and certification.
• Assist physicians and other departments with developing, implementing, and monitoring protocols.
• Use data-based decision-making and support compliance with state and federal regulators, accreditation agencies, and other legal regulatory bodies.
• Support service-line initiatives and plan for future program development and the use of space, facilities, and equipment.
• Maintain utilization review and discharge planning functions in accordance with accreditation and licensure requirements; actively support the Utilization Review Committee.
• Develop, maintain, and evaluate integrated systems that enable Clinical Resource Management and Social Services teams to use InterQual criteria for hospitalized and outpatient patients.
• Perform other related duties as assigned or requested.

What This Job Offers

• Job Type: Full-time
• Career Level: Director