The Director of Case Management and Social Work (CMSW) provides strategic and operational leadership to ensure high-quality, patient-centered care that responsibly serves both the community and the organization. This role is instrumental in advancing equitable access to care, supporting vulnerable populations, and strengthening partnerships across the care continuum to reduce preventable readmissions and improve health outcomes.
As a high functioning leader, the Director oversees all daily operations of the Case Management and Social Work departments, fostering a collaborative, high-performing team culture built on accountability, professional development, and compassionate service. The Director recruits, mentors, and manages department staff while promoting interdisciplinary collaboration with medical, nursing, HIM, and senior leadership teams.
With a strong focus on fiscal responsibility, the Director drives effective resource utilization to reduce length of stay and cost per case without compromising quality of care. Through data-driven decision-making and utilization management, the role ensures responsible stewardship of organizational and community resources.
The Director serves as the critical link between clinical documentation, compliance, and reimbursement, working closely with the HIM department and providers to ensure accurate physician documentation that reflects severity of illness and complexity of care. Deep knowledge of CMS regulations and Conditions of Participation is essential to maintaining compliance and supporting sustainable operations.
Responsibilities:- Provides supervision and guidance to Case Management (CM) staff - scheduling, performance management, training, and accurate and concise documentation. The director plays a critical role in team building and support of front line staff.
- Leadership of Complex Case Meetings and Monitors Interdisciplinary Rounds (IDRs) -Plays an active role co-chairing IDR work group. Collaborates with nursing to ensure the work group is meeting at minimum monthly to report and review audit scores, identify opportunities for improvement, and develop and implement action plans to improve IDR processes and outcomes.
- Performs Audits of Case Management Staff Assessments, Reviews and Documentation - Assists with regulatory compliance and risk management
- Maintain an Active Role in Denials and Appeals - Verifies staff comprehension and utilization of HINNs, MOON, IMM and other required payer/government notices and escalates concerns to Physician Advisor, COO/CNO, and/or CFO as appropriate
Requirements:- A Bachelor's degree is required.
- Bachelor's in nursing or Social Work, Masters' Degree in a related field is preferred.
- Candidates must have a minimum of five (5) years' leadership experience in Case Management, Utilization Management and Quality Assessment, or a minimum of five (5) years' leadership experience in a related field, acute care experience strongly preferred.
- Eligible for or certified in Case Management is desirable.
- Extensive knowledge of all CMS regulations and conditions of participation is essential.
Salary Range: $41.30-$61.94 /hour Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.
