Description & Requirements The Senior Director of Utilization and Case Management drives execution, alignment, and performance of care management programs in the acute care system, ensuring consistent standards, scalable processes, and sustainable outcomes at the individual hospital level. This role provides critical system leadership to critical to advancing a high-performing, integrated care management model across our acute care system.
The ideal candidate will have a clinical background (RN or social work preferred), deep experience in utilization review and inpatient case management, proven results in LOS, denials and throughput, and strength in leading teams in a matrixed health system.
What You Can Expect: - Provide system-wide leadership, oversight, and accountability for utilization review, case management, and inpatient social work
- Lead employee and provider engagement efforts, including interdisciplinary rounding (IDTs), coaching, and action planning
- Ensure operational effectiveness and consistency across facilities, including staffing models aligned with best practices and appropriate skill mix
- Develop and execute mid- to long-term strategic plans, driving measurable improvements in:
- Length of stay (LOS) and avoidable days
- Denial rates, appeals, and payer performance
- Care transitions, readmissions, and patient experience
- Ensure consistent application of evidence-based criteria
- Partner with the SVP, Chief Physician Executive, and Chief Physician Advisor to advance utilization management, physician engagement, and clinical documentation improvement (CDI)
- Lead cross-functional initiatives that align operational, clinical, quality, and financial goals across the system
- Oversee appeals and grievance processes, ensuring alignment with payer requirements and system strategy
- Drive standardization and continuous improvement in workflows, resource utilization, and care management practices
- Ensure regulatory compliance and adherence to system policies and standards
Qualifications: - Master's degree or bachelor's plus 2 additional years of experience
- 8 years of experience
What's In It For YouAt St. Luke's, caring for people in the communities we serve is our mission - and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on-site massages, on-site counseling via our Employee Assistance Program, access to the Personify Health Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals.
*Please note: this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.
