Director of Case Management
About The Position
We are seeking an experienced Director of Case Management to lead hospital-based case management operations focused on utilization management, patient throughput, care coordination, reimbursement optimization, and regulatory compliance within a large acute-care environment. This leadership role is ideal for a results-driven healthcare professional passionate about improving patient outcomes, operational efficiency, and interdisciplinary collaboration. The Director of Case Management will oversee the operational and strategic management of the hospital’s Case Management department, ensuring effective utilization of resources, compliance with CMS and accreditation standards, and optimal patient transition planning. This role partners closely with physicians, nursing leadership, revenue cycle, and executive stakeholders to drive performance improvement initiatives and support high-quality patient care delivery.
Requirements
- Bachelor’s degree in Nursing, Social Work, or related healthcare field
- Active RN or LCSW/LMSW license
- 3–5+ years of acute hospital case management leadership experience
- Strong experience with utilization management, patient throughput, and reimbursement processes
- Knowledge of CMS regulations, Joint Commission standards, and care coordination best practices
- Strong leadership, communication, and interdisciplinary collaboration skills
Nice To Haves
- Master’s degree in Nursing, Healthcare Administration, Business Administration, or related field
- Accredited Case Manager (ACM) certification
- InterQual experience preferred
- Experience with business planning, operational metrics, and performance improvement initiatives
Responsibilities
- Lead daily operations of the Case Management department across utilization management, transition planning, and care coordination
- Ensure appropriate staffing levels, productivity, and department performance metrics
- Oversee staff training, competencies, evaluations, and ongoing development
- Implement and oversee medical necessity review processes and denial prevention strategies
- Ensure accurate level-of-care determinations and compliance with CMS regulations
- Partner with payers, physicians, and revenue cycle teams to optimize reimbursement outcomes
- Analyze avoidable days, denials, and utilization trends to drive operational improvement initiatives
- Ensure timely discharge planning and transition assessments within regulatory timeframes
- Collaborate with interdisciplinary teams to support patient throughput and safe transitions of care
- Participate in bed management and complex case review processes
- Ensure compliance with federal, state, CMS, Joint Commission, and organizational case management standards
- Monitor documentation quality and adherence to case management policies and procedures
- Support audit readiness and implementation of corrective action plans as needed
- Provide physician and staff education on utilization management, medical necessity, and compliance requirements
- Present performance data and utilization trends to leadership and committees
- Foster a collaborative, patient-centered culture focused on quality and efficiency
Benefits
- Comprehensive medical, dental, vision, and life insurance
- 401(k) with employer match
- Generous PTO and continuing education opportunities
- Flexible spending accounts and wellness programs
- Relocation assistance available for qualified candidates
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What This Job Offers
Job Type
Full-time
Career Level
Director
