Director of Care Management

Trinity Health • Langhorne, PA

7d

About The Position

The Director of Care Management will direct the department in a collaborative model focused on patient-centered care and the deliberate organization of services across the continuum. This role bridges the acute setting and community transition by establishing formal partnerships and ensuring seamless information sharing among multidisciplinary teams to eliminate barriers to discharge. The goal is to facilitate communication and resource coordination through advocacy, education, and comprehensive assessment of social determinants, while managing transitions and disease management programs. Responsibilities include the oversight of compliance standards and clinical outcomes—specifically targeting reduced fragmentation in care and optimized length of stay to improve readmission rates, capacity management, and financial indicators.

Requirements

• Master of Science in Nursing (MSN) degree from an accredited school of nursing required.
• Current Registered Nurse license by Pennsylvania Board of Nursing or Compact State.
• At least 3-5 years' leadership experience in case management

Nice To Haves

• CCM (Certified Case Manger) or ACM (Accredited Case Manager) preferred

Responsibilities

• Directs the overall care management program, including case management, social work, and utilization review.
• Maintains collaborative relationship with Medical Staff and facilitates education on documentation, government regulations and payer contracting matters
• Oversees processes to ensure patients are at the correct level of care (e.g., observation vs. inpatient) and that hospital resources are used efficiently.
• Lead the Utilization Management Committee to report on denial trends and resource consumption
• Assures hospital adherence to all Federal, State, and Local regulatory and compliance guidelines related to utilization
• Oversight of critical processes related to compliance of both medical necessity and appropriate level of care; coordinates utilization review processes to assure adherence to regulations
• Supports the Utilization Management and Appeals Supervisor and the Manager of Care Management to assure the functions of care coordination in the acute setting meet the goals of resource consumption, capacity management and patient centered care
• Develops programs to support length of stay initiatives to manage capacity and assure the right care at the right time
• Assures hospital adherence to all regulatory guidelines related to discharge planning
• Continuously seeks best practice approaches to assuring patients are discharge ready including coordination of services, coaching, and transition of information

Benefits

• Comprehensive benefit packages, including medical, dental, vision, mental health, paid time off, 403B, education assistance and voluntary benefits (pet insurance, accident insurance, hospital indemnity and others) available from the first day of employment.
• Work/Life balance with flexible schedules.
• Free onsite parking.
• Referral Rewards Program

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 251-500 employees