Director Case Management

Nexus Health Systems Ltd•Dallas, TX

About The Position

The Director of Case Management is responsible for leading and managing the Case Management Department, ensuring the delivery of high-quality, patient-centered care through effective care coordination, discharge planning, and utilization management. This role oversees regulatory compliance, promotes clinical excellence, supports professional development, and drives initiatives that enhance patient outcomes, operational efficiency, and financial performance. The Director serves as a key liaison between patients, providers, and external partners to ensure seamless care transitions and optimal resource utilization.

Requirements

Bachelor’s or Master’s Degree in Nursing (BSN/MSN) or Social Work (BSW/MSW) required
Minimum 5 years of acute hospital case management experience
Minimum 2–3 years in a leadership role within a hospital setting
Strong knowledge of utilization management, discharge planning, and regulatory standards
Experience with CMS, DNV/Joint Commission, and performance improvement initiatives
Strong analytical, organizational, and problem-solving skills
Excellent communication and leadership abilities
Proven ability to collaborate with physicians and interdisciplinary teams
Knowledge of managed care, inpatient/outpatient continuum, and resource management
Current Texas licensure as RN, LBSW, or LMSW required
Case Management Certification (ACM, CCM, CMGT, or FAACM) required or must be obtained within 2 years

Responsibilities

Direct daily operations of the Case Management Department to ensure efficient service delivery
Lead, mentor, and develop Case Management staff, fostering a high-performing team
Support and communicate the Mission, Vision, and Values of Nexus Health Systems
Collaborate across departments to ensure seamless patient care coordination
Facilitate interdisciplinary care planning and ensure alignment across treatment teams
Lead multidisciplinary team conferences and ongoing case reviews
Oversee discharge planning processes to ensure safe, timely transitions of care
Monitor patient progress and adjust care plans to optimize outcomes
Ensure accurate and comprehensive clinical documentation
Oversee utilization review processes to ensure medical necessity and appropriate level of care
Co-manage utilization management meetings, including review of outlier cases
Ensure compliance with CMS, DNV/Joint Commission, HIPAA, and state regulations
Maintain oversight of documentation supporting reimbursement and continued stay
Advocate for patients and families, ensuring their needs guide care planning
Support access to community resources, financial assistance, and post-acute services
Provide guidance on complex cases, including end-of-life care coordination
Ensure equitable delivery of services regardless of payer source
Conduct audits and lead quality improvement initiatives
Identify trends, barriers, and opportunities to enhance care delivery
Promote a culture of safety, compliance, and continuous improvement
Develop and manage departmental budgets
Optimize resource utilization while maintaining quality care
Partner with payors and stakeholders to support financial performance
Identify cost-saving opportunities without compromising patient outcomes