Job Description

Job Description

Job Description

Our client is seeking a Director of Case Management to lead and oversee the Case Management unit, which includes clinical resource management, discharge planning, patient advocacy, clinical social work, and medical necessity review. The Director will ensure adherence to best practices and optimize patient care coordination while managing performance improvement initiatives across the continuum of care. This role requires strong leadership, clinical expertise, and the ability to work closely with physicians, medical staff, and external post-acute service providers.

Responsibilities:

• Plan, organize, and direct all activities of the Case Management department, including staffing, resource utilization, and performance improvement.
• Ensure clinical services align with organizational goals, including reduction of Length of Stay (LOS) and adherence to care plans.
• Oversee care coordination activities in compliance with organizational policies, medical group needs, and federal/state regulations.
• Collaborate with leadership, physicians, and community-based healthcare providers to streamline patient transitions post-discharge.
• Lead and participate in strategic planning, performance improvement initiatives, and reporting requirements.
• Develop departmental goals and integrate evidence-based practices into operations and protocols.
• Educate and mentor staff and physicians on case management standards, utilization review processes, and regulatory compliance.
• Monitor payer issues, patient management decisions, and financial implications to ensure appropriate expense reduction and revenue capture.
• Foster an environment of professional growth and effective communication across multidisciplinary teams.
• Ensure the Utilization Review process aligns with Medicare, Medicaid, and commercial payer guidelines.
• Optimize care coordination programs to meet patient needs across all health stages.

Must Haves:

• Associate's Degree in Nursing required.
• Current RN license to practice in NC (NC licensure or multi-state/compact license).
• BLS Certification required.
• CCM Certification (must be completed within the first year of employment or role transfer).
• Minimum of 3 years of acute care RN or Care Coordination experience required.
• Requires critical thinking skills, decisive judgment, and the ability to work in high-stress environments.
• Strong knowledge of care management, discharge planning, Interqual criteria, and government billing regulations.
• Effective leadership, communication, and problem-solving skills.

Nice to Have:

• Bachelor's Degree in Nursing or Master's Degree in a related field preferred.
• ACMA Certification preferred.
• Minimum of 3 years of management experience preferred.
• Working knowledge of Joint Commission standards, Conditions of Participation, and budgetary processes.
• Demonstrated ability to manage multiple projects and deliver results in fast-paced environments.

Location: Rutherfordton, NC

Salary: $102,000 - $145,000

• Signing Bonus: Negotiable
• Full Relocation Package provided.

Benefits:

• Competitive medical, dental, and vision insurance options.
• Health Savings Account (HSA).
• 401(k) retirement plan contributions.
• Generous Paid Time Off.
• Accident & Critical Illness Insurance.
• Short- and Long-term Disability Insurance.
• Life Insurance.
• Employee Assistance Program available 24/7.
• Prescription Assistance with OptumRx.
• Free travel and entertainment discount programs.
• Identity Theft Protection.

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