The client is seeking a Director of Case Management to provide administrative leadership across Utilization Review, Integrated Clinical Service, Discharge Planning, and Care Transitions. This role will lead and inspire the case management team to drive operational effectiveness and enhance patient care by ensuring timely, appropriate transitions and compliance with relevant regulatory requirements.
The director will oversee utilization review and integrated clinical services, maximize access to and efficient use of multidisciplinary resources, and support patient placement, throughput, length of stay, and timely transitions. Key responsibilities include chairing a quarterly utilization review committee (including preparing agendas and minutes and disseminating reports), leading daily interdisciplinary patient rounds and length-of-stay meetings, and maintaining effective communication with patients, families, physicians, payers, and other healthcare stakeholders.
The position requires a BSN, current MA licensure, and 3–5 years of case management leadership experience, including experience in utilization review, discharge planning, and integrated clinical services. The director should have in-depth knowledge of acute care case management, medical necessity criteria, length-of-stay management, readmission reduction, and transitions of care, along with strong skills in quality, data management, analysis, reporting, and regulatory knowledge related to state and federal requirements, Joint Commission standards, HIPAA, and Medicare COP; a master’s degree is preferred. The role also expects excellent oral and written communication, strong leadership and team-building abilities, and the ability to mentor staff while fostering accountability, including expertise in Medicare/Medicaid/commercial claims review and denial processes and appeals preparation and submission.