Job SummaryThe Director - Case Management directs Case Management and Utilization Management activities within a ScionHealth hospital. This role oversees the coordination of care for patients and families through effective management of clinical service delivery, ensuring quality outcomes and efficient resource utilization.
The Director partners with external customers, referral sources, and payors to facilitate effective discharge planning while serving as a patient and family advocate. This position is accountable for the facility's denial management program and ensures case management services comply with regulatory requirements, including the Conditions of Participation. The Director collaborates closely with hospital executive leadership including the CEO/Administrator, COO, CFO, CCO, and Regional Office leadership.
Essential Functions- Oversees coordination of patient care to support development, monitoring, and refinement of individualized treatment plans.
- Assumes responsibility for the effective daily operations of the Case Management Department.
- Ensures regular, accurate, and timely reporting of case management performance outcomes and key metrics.
- Promotes ScionHealth hospitals within the provider community and local educational institutions when appropriate.
- Implements and monitors processes to ensure optimal utilization of resources and appropriate reimbursement.
- Participates as a member of the Utilization Management Committee and other hospital committees as required.
- Identifies opportunities to achieve hospital goals using comparative data, performance metrics, and benchmarking.
- Aggregates and analyzes hospital utilization services statistics and recommends corrective actions when necessary.
- Ensures departmental compliance with CMS, state, and accreditation standards, including documentation and record requirements.
- Participates actively in surveys, audits, and regulatory reviews.
- Supports organizational initiatives that improve care coordination, patient outcomes, and operational performance.
Knowledge, Skills, and Abilities- Thorough knowledge of case management processes, utilization management practices, and care coordination models.
- Experience managing case management programs using an interdisciplinary team approach.
- Strong leadership skills with the ability to motivate, guide, and develop staff.
- Excellent interpersonal, verbal, and written communication skills to collaborate effectively with leadership, physicians, payors, and external stakeholders.
- Knowledge of accreditation standards, regulatory requirements, and compliance expectations.
- Knowledge of government and commercial payor practices, regulations, and reimbursement methodologies.
- Strong critical thinking, prioritization, and time management skills.
- Proficiency with Microsoft Office applications including Word, Excel, and other productivity tools.
- Ability to maintain confidentiality and adhere to organizational policies and regulatory requirements.
- Must be able to read, write, and speak fluent English.
- Maintains regular attendance and availability as required to support departmental operations.
- Ability to travel approximately 5% as needed.
- Performs other related duties as assigned.
Pay range: $125K - $160K/Yr ScionHealth has a comprehensive benefits package for benefit-eligible employees that includes Medical, Dental, Vision, 401(k), FSA/HSA, Life Insurance, Paid Time Off, and Wellness.
QualificationsEducation- Bachelor's Degree in a clinical field. (Required)
- Bachelor's Degree in Nursing. (Preferred)
- Equivalent combination of education and experience. (May be considered)
Licenses/Certifications- Registered Nurse (RN) - State Licensure and/or Compact State Licensure or Respiratory Therapist or Physical Therapist or Occupational Therapist or Social Worker (LSW or LCSW). (Required upon hire)
- Certified Case Manager (CCM), Accredited Case Manager (ACM), or Certified Rehabilitation Registered Nurse (CRRN). (Preferred upon hire)
Experience- Three (3) or more years of experience in hospital case management. (Required)
- Prior experience in a leadership or interim director role. (Preferred)
- Experience demonstrating familiarity with managed care, reimbursement practices, and regulatory standards. (Required)
