Director of Case Management

About the Role

We are seeking an experienced and strategic Director of Case Management to lead and oversee hospital-based case management operations. This leadership role is responsible for driving patient-centered care coordination, optimizing utilization management, improving length of stay, and ensuring regulatory compliance while supporting clinical and financial outcomes.

The ideal candidate is a collaborative leader with strong acute care experience who can effectively partner with physicians, nursing leadership, social work, and executive teams in a fast-paced hospital environment.

• Provide strategic, operational, and clinical leadership for Case Management, Utilization Review, and Care Coordination services
• Oversee daily department operations, staffing models, workflows, and productivity
• Lead initiatives focused on length of stay (LOS) management, discharge planning, readmission reduction, and patient throughput
• Ensure effective utilization management, level-of-care determinations, denial prevention, and payer communication
• Collaborate with physicians, nursing leadership, social work, and interdisciplinary teams to improve patient outcomes
• Monitor and analyze performance metrics, KPIs, and quality indicators to drive continuous improvement
• Ensure compliance with CMS, Joint Commission, and other regulatory and accreditation standards
• Support financial stewardship through efficient resource utilization and revenue integrity
• Lead, mentor, and develop case management staff, fostering a culture of accountability and excellence
• Participate in organizational planning, policy development, and performance improvement initiatives

• Bachelor’s degree required (master’s in healthcare administration, Nursing, or related field preferred)
• Active RN license required or strongly preferred (based on organizational policy)
• 7–10+ years of progressive experience in hospital-based case management or care management
• Demonstrated leadership experience managing case management or utilization review teams
• Strong knowledge of utilization management, discharge planning, and care coordination processes
• Experience with Inter Qual, MCG, or similar utilization review criteria
• Proven ability to lead in a fast-paced, high-acuity acute care environment

• Director or senior leadership experience in Case Management
• Experience in acute care hospitals or health systems
• Strong data-driven decision-making and performance improvement skills
• Excellent communication, collaboration, and leadership capabilities