Director Inpatient Care Management
About The Position
The Director Inpatient Care Management provides strategic and operational leadership for care management, utilization management, discharge planning, transitions of care for the acute care setting, and population health initiatives across a three-hospital health system. This leader is responsible for ensuring regulatory compliance, optimizing resource utilization, improving patient outcomes, reducing avoidable readmissions, and supporting financial performance through effective utilization review and care coordination practices. The Director collaborates closely with executive leadership, physicians, nursing leaders, case managers, social workers, revenue cycle teams, and community partners to ensure patients receive the right care, in the right setting, at the right time.
Requirements
- Bachelor’s degree in nursing AND a master's degree in a health-related/science field.
- New Hampshire Registered (RN) License
- Minimum of 7–10 years of progressive leadership experience in Care Management, Case Management, Utilization Review, or Population Health.
- Minimum of 5 years of management experience within a hospital or integrated health system.
Nice To Haves
- Certified Case Manager (CCM), Accredited Case Manager (ACM), or related certification strongly preferred.
- Experience overseeing multi-site or multi-hospital operations preferred.
Responsibilities
- Demonstrated success and process improvement in utilization management, denial prevention, throughput improvement, and care transition initiatives
- Develop and implement a system-wide vision, strategy, and operational plan for Care Management and Utilization Review.
- Standardize care management and utilization review processes across all hospitals and care settings.
- Lead initiatives that improve quality outcomes, patient experience, throughput, length of stay, and cost-effective care delivery.
- Support organizational goals related to value-based care, population health, and regulatory compliance.
- Direct inpatient and outpatient care management services, including case management, social work, discharge planning, and care coordination.
- Ensure timely and effective patient assessments, care planning, and transition-of-care activities.
- Promote interdisciplinary collaboration to address clinical, psychosocial, and financial barriers to care.
- Develop programs that reduce readmissions and improve post-acute care transitions.
- Oversee utilization review processes to ensure appropriate level of care determinations and compliance with payer requirements.
- Monitor medical necessity reviews and authorization processes.
- Collaborate with physicians and clinical documentation teams to support accurate patient status determinations.
- Lead denial prevention and appeals strategies to minimize revenue loss and improve reimbursement.
- Analyze utilization and length-of-stay data to identify opportunities for improvement.
- Ensure compliance with CMS Conditions of Participation, Joint Commission standards, state regulations, and payer requirements.
- Maintain readiness for regulatory surveys, audits, and accreditation reviews.
- Leadership and staff development.
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What This Job Offers
Job Type
Full-time
Career Level
Director
