Director of Inpatient Care and Utilization Review

Humboldt County Memorial Hospital•Humboldt, IA

11d•Onsite

About The Position

The Director of Inpatient Care provides strategic, clinical, and operational leadership for all inpatient services within the Critical Access Hospital (CAH). This role has direct management responsibility for all inpatient unit staff and ensures the delivery of safe, high-quality, patient-centered care. The Director is responsible for staffing, performance management, regulatory compliance, fiscal stewardship, and oversight of utilization review and care coordination to ensure appropriate use of hospital resources.

Requirements

Current RN license in the state of practice.
Working knowledge of utilization review, care management, and Critical Access Hospital regulations.

Nice To Haves

Bachelor’s degree in Nursing (BSN) or related healthcare field.
Minimum of 5 years of progressive inpatient nursing leadership experience with direct staff management responsibility.
Experience in a Critical Access Hospital or rural healthcare setting.
Certification in Nursing Leadership, Case Management, or Utilization Management (e.g., ACM, CCM).

Responsibilities

Provide direct leadership and management for all inpatient unit staff, including registered nurses, licensed practical nurses, nursing assistants, unit clerks, and other assigned inpatient personnel.
Recruit, hire, onboard, evaluate, coach, and, when necessary, discipline inpatient staff in accordance with hospital policy.
Develop and maintain staffing plans that align with patient acuity, census variability, and Critical Access Hospital requirements.
Foster staff engagement, retention, professional development, and competency validation.
Ensure adequate coverage for all shifts, including coordination of schedules, call coverage, and contingency staffing.
Oversee day-to-day operations of inpatient nursing units, swing bed, hospice and observation services.
Ensure effective patient throughput, bed management, and coordination with emergency, ancillary, and outpatient services.
Participate in budget development, productivity monitoring, and variance management for inpatient services.
Ensure inpatient care delivery meets evidence-based standards and regulatory requirements.
Monitor and improve key quality indicators such as falls, pressure injuries, hospital-acquired conditions, readmissions, and patient satisfaction.
Assist with root cause analyses and corrective action plans related to inpatient care events.
Oversee the utilization review (UR) and care management functions for inpatient and observation services.
Ensure appropriate admission status determination and documentation (inpatient vs. observation).
Monitor medical necessity, length of stay, and CMS Critical Access Hospital billing compliance.
Lead and participate in interdisciplinary rounds to support care progression and timely discharge planning.
Review payer denials and audit findings; implement education, workflow improvements, and corrective actions.
Ensure inpatient unit compliance with CMS Conditions of Participation, state regulations, and accrediting body standards.
Maintain policies, procedures, and competencies related to inpatient and swing bed services.
Lead inpatient survey readiness and serve as a key contact during regulatory reviews.
Collaborate with providers, case management, therapy, pharmacy, quality, and ancillary departments.
Serve as a key liaison between inpatient services and hospital leadership.
Promote effective communication across all disciplines and shifts.