Director of Case Management

Job Summary The Director of Case Management leads the hospital’s Case Management and Social Services functions, ensuring coordinated, high-quality, and compliant patient care across the continuum. This role partners closely with physicians, nursing leadership, interdisciplinary teams, payors, and community providers to support effective care transitions, appropriate utilization of services, and positive patient outcomes. The Director oversees utilization management activities to ensure medical necessity, appropriate level of care, and efficient length of stay, while maintaining a patient- and family-centered approach.

Key Responsibilities Lead and oversee Case Management and Social Services operations Guide utilization management activities, including admission status review, continued stay review, and denial prevention Ensure compliance with CMS, Medicare Conditions of Participation, and payer requirements Partner with physicians and clinical leaders to support appropriate level of care and care progression Develop and refine care coordination processes that improve outcomes and reduce avoidable days Coordinate with payors and post-acute providers including SNFs, long-term care, home health, and transportation services Monitor and improve performance metrics such as length of stay, readmissions, and denials Mentor and support Case Management staff through collaborative leadership Participate in hospital committees and performance improvement initiatives

Licensure & Certification Active Texas Registered Nurse (RN) license required Case Management certification preferred (CCM, ACM)

Education Bachelor’s degree in Nursing required Master’s degree in Nursing, Healthcare Administration, or related field preferred

Experience Experience in hospital Case Management or Care Coordination required Prior leadership or supervisory experience preferred Strong understanding of utilization management and payer processes in an acute care setting