Director Of Case Management

Director of Case Management Overview

• The Director of Case Management oversees case management operations, ensuring effective utilization review, discharge planning, and care coordination within a healthcare setting.
• Lead efforts to stabilize operations and improve throughput and length-of-stay metrics across the department.
• Collaborate with interdisciplinary teams to ensure compliance with CMS regulations and InterQual/MCG criteria.
• Provide leadership during transitional periods, assessing team performance and implementing strategic improvements.
• Work closely with hospital leadership to align case management goals with organizational objectives.
• Ensure the department delivers high-quality care coordination and denial management services.
• Foster a culture of accountability and excellence within the case management team.
• Support staff development and training to enhance departmental capabilities.
• Maintain compliance with regulatory standards and organizational policies.

Director of Case Management Key Responsibilities & Duties

• Oversee daily operations of the case management department, ensuring optimal resource utilization and care coordination.
• Develop and implement strategies to improve patient throughput and reduce length of stay.
• Monitor compliance with CMS regulations and InterQual/MCG criteria, addressing any gaps proactively.
• Provide leadership and guidance to the case management team during transitional periods.
• Collaborate with interdisciplinary teams to streamline discharge planning processes.
• Analyze departmental performance metrics and implement improvement initiatives.
• Ensure effective denial management practices to minimize revenue loss.
• Facilitate staff training and professional development opportunities.
• Maintain high standards of patient care and operational efficiency.

Director of Case Management Job Requirements

• Associate of Science (AS) degree required; BSN or higher preferred.
• Active Registered Nurse (RN) licensure in California is mandatory.
• Minimum of 2 years of acute-care case management leadership experience.
• Familiarity with CMS regulations, InterQual/MCG criteria, and denial management processes.
• ACM or CCM certification is preferred.
• Proven ability to assess team performance and implement operational improvements.
• Strong leadership skills with a focus on patient care and team accountability.
• Experience in a large health system environment is advantageous.
• Excellent communication and collaboration skills.