Director of Case Management

Kindred Healthcare•Los Angeles, CA

1h•$124,324 - $181,875•Onsite

About The Position

The Director of Case Management directs Case Management and Utilization Management activities at a ScionHealth hospital. The role oversees coordination of care for patients and families through clinical service delivery, supporting quality outcomes and efficient resource use. The Director works with external customers, referral sources, and payors to support discharge planning and advocates for patients and families. The position is accountable for the facility’s denial management program and ensures case management services comply with regulatory requirements, including Conditions of Participation. The Director collaborates with hospital executive leadership and Regional Office leadership.

Requirements

Bachelor’s degree in a clinical field (required); an equivalent combination of education and experience may be considered.
State or compact-state licensure as a Registered Nurse, Respiratory Therapist, Physical Therapist, Occupational Therapist, or Social Worker (LSW or LCSW), required upon hire.
Three or more years of hospital case management experience.
Experience demonstrating familiarity with managed care, reimbursement practices, and regulatory standards.
Thorough knowledge of case management processes, utilization management practices, and care coordination models.
Experience managing case management programs using an interdisciplinary team approach.
Strong leadership skills and ability to motivate, guide, and develop staff.
Excellent interpersonal, verbal, and written communication skills to collaborate with leadership, physicians, payors, and external stakeholders.
Knowledge of accreditation standards, regulatory requirements, and compliance expectations.
Knowledge of government and commercial payor practices, regulations, and reimbursement methodologies.
Strong critical thinking, prioritization, and time management skills.
Proficiency with Microsoft Office applications, including Word and Excel, and other productivity tools.
Ability to maintain confidentiality and comply with organizational policies and regulatory requirements.
Fluent English reading, writing, and speaking skills.
Regular attendance and availability as required to support departmental operations.
Ability to travel approximately 5% as needed.

Nice To Haves

Bachelor’s degree in Nursing.
Certified Case Manager (CCM), Accredited Case Manager (ACM), or Certified Rehabilitation Registered Nurse (CRRN), preferred upon hire.
Prior experience in a leadership or interim director role.

Responsibilities

Oversee coordination of patient care, including development, monitoring, and refinement of individualized treatment plans.
Manage the daily operations of the Case Management Department.
Ensure regular, accurate, and timely reporting of case management performance outcomes and key metrics.
Promote ScionHealth hospitals within the provider community and local educational institutions when appropriate.
Implement and monitor processes that support optimal resource utilization and appropriate reimbursement.
Participate in the Utilization Management Committee and other hospital committees as required.
Identify opportunities to achieve hospital goals using comparative data, performance metrics, and benchmarking.
Aggregate and analyze hospital utilization services statistics and recommend corrective actions when necessary.
Ensure departmental compliance with CMS, state, and accreditation standards, including documentation and record requirements.
Participate in surveys, audits, and regulatory reviews.
Support organizational initiatives to improve care coordination, patient outcomes, and operational performance.
Perform other related duties as assigned.