Director of Integrated Care Mgmt

Chesapeake Regional Healthcare•Chesapeake, VA

About The Position

The Director of Integrated Care Management provides strategic, operational, and clinical leadership for the Integrated Care Management Department, ensuring coordinated, patient-centered, high-quality, and fiscally responsible care across the continuum. The role oversees Utilization Review, RN and Social Work Case Management, Clinical Social Work Services, the Readmission Prevention Program, Congestive Heart Failure (CHF) Navigation, the HOPE Program, and other care management initiatives supporting safe transitions, effective resource use, and optimal patient outcomes. The Director leads departmental strategy, financial stewardship, regulatory compliance, accreditation readiness, quality improvement, and operational performance. The role ensures compliance with applicable federal and state regulations, including CMS Conditions of Participation, payer requirements, and the hospital's accreditation standards. In collaboration with physicians and organizational leaders, the Director advances care progression, utilization management, patient flow, readmission reduction, patient experience, and equitable access to care. The Director establishes departmental vision, goals, performance metrics, policies, workflows, and regulatory strategies; leads improvement initiatives; and manages departmental budgets, staffing, productivity, workforce planning, contractual agreements, and resources. The position builds partnerships across clinical and operational teams, post-acute providers, and community agencies, and represents the department on committees and work groups. The position reports to the Chief Clinical Officer and provides direct and indirect leadership for the Integrated Care Management Department.

Requirements

Master’s degree in nursing, Business Administration, Healthcare Administration, or a related healthcare field, or agreement to obtain the degree within three years of hire.
At least five years of progressively responsible experience in acute healthcare, including care management, utilization management, care coordination, or related clinical or healthcare operations.
At least two years of progressive leadership experience within an acute care Case Management, Utilization Management, or Integrated Care Management department.
Active Registered Nurse (RN) license in the Commonwealth of Virginia.
Certification as an Accredited Case Manager (ACM) or Certified Case Manager (CCM).

Responsibilities

Provide strategic, operational, and clinical leadership for the Integrated Care Management Department and its programs.
Establish departmental vision, strategic priorities, goals, performance metrics, and regulatory strategies aligned with organizational objectives.
Lead development, implementation, and evaluation of initiatives to improve patient outcomes, care delivery, operational efficiency, compliance, care progression, and organizational performance.
Lead managers and direct reports, fostering accountability, collaboration, innovation, professional development, continuous improvement, and evidence-based practice.
Direct care coordination, utilization management, care progression, discharge planning, transitions of care, and resource utilization across the continuum.
Ensure compliance with federal and state regulations, CMS Conditions of Participation, payer requirements, patient rights, and accreditation standards.
Develop and evaluate departmental policies, procedures, documentation standards, competencies, workflows, and evidence-based practices.
Lead performance improvement initiatives addressing care progression, resource utilization, compliance, patient outcomes, length of stay, avoidable days, medically ready patients, readmissions, and transitions of care.
Oversee interdisciplinary care management services, including discharge planning, behavioral health and psychosocial intervention, community resource management, patient advocacy, equitable access, and safe transitions.
Oversee Utilization Review nursing, including timely medical necessity review, patient status determination, regulatory compliance, appropriate reimbursement, and collaboration with Physician Advisors, Revenue Cycle, and clinical leadership.
Develop, administer, and monitor operating and personnel budgets; oversee productivity, workforce planning, staffing, contractual agreements, capital requests, and operational improvements.
Monitor quality, operational, financial, and regulatory metrics; use data to identify opportunities, evaluate outcomes, and implement sustainable process improvements.
Collaborate with executive leadership and finance, quality, performance analytics, revenue cycle, and operational leaders on patient flow, throughput, capacity management, and healthcare value.
Build collaborative relationships with physicians, nursing, ancillary departments, post-acute providers, community agencies, and executive leadership.
Provide administrative oversight of multidisciplinary discharge planning and length-of-stay initiatives, facilitating collaboration and barrier resolution.
Represent the department on organizational committees, interdisciplinary work groups, ethics committees, and community partnerships.
Collaborate with legal counsel, finance, revenue cycle, compliance, quality, risk management, and community partners to develop strategic initiatives, programs, agreements, and operational solutions.
Provide leadership for departmental strategy, operations, financial stewardship, regulatory compliance, quality improvement, workforce development, and achievement of organizational goals.