Director - Case Management
Job Description
The Director of Case Management is responsible for planning, directing, and evaluating the strategic clinical workflows, utilization reviews, and discharge navigation programs across the healthcare facility. The role ensures the successful execution of length-of-stay optimization, audit compliance, and interdisciplinary care transitions while protecting institutional resources and patient care quality.
Required Qualifications * Bachelor’s or Master's degree in Nursing (BSN/MSN) from an accredited institutional program.
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Active, unrestricted Registered Nurse (RN) license within the state of practice.
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Certified Case Manager (CCM) or equivalent professional healthcare management credential.
Preferred Skills * Outstanding administrative leadership, fiscal navigation, and conflict resolution capacities.
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Comprehensive knowledge of acute hospital throughput dynamics and utilization review criteria (e.g., InterQual or Milliman).
Experience Required 5+ years of progressive leadership experience steering hospital case management, social work, or utilization coordination groups.
Responsibilities Duties:
Key Responsibilities * Coordinate and execute department-wide operational strategies, budget boundaries, and clinical case tracking frameworks.
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Prepare departmental performance reports, compliance audits, and strategic resource allocation charts.
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Define unified care coordination models matching external managed care and federal parameters.
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Coordinate with hospital executives, attending physicians, nursing managers, and insurance networks.
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Monitor active patient utilization metrics and promptly address systemic discharge delays or insurance denials.
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Maintain full alignment with CMS guidelines, joint commission standards, and regional healthcare laws.