Director of Case Management

The Director – Case Management directs Case Management and Utilization Management activities. 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 CNO

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.

• 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.