Director of Care Management

Our client, a leading healthcare organization, is hiring a Director of Care Management. The Director of Care Management will provide visible, hands-on leadership for hospital-based care management operations, including case management, social work, utilization review, clinical documentation, transitional care, and resource utilization. Reporting to senior clinical leadership, this director will lead multidisciplinary teams, improve inpatient throughput and care transitions, and strengthen collaboration among hospital, ambulatory, post-acute, community, and outsourced partners.

Responsibilities

• Lead daily operations, performance, staffing, development, and accountability for care management and related teams, including managers and multidisciplinary personnel.
• Oversee inpatient care coordination, admission and discharge planning, utilization management, social work, clinical documentation, denial appeals, and transitional care.
• Ensure compliance with regulatory, accreditation, payer, and applicable quality standards.
• Develop strategies to reduce readmissions, improve patient outcomes, enhance patient and family satisfaction, and support value-based care.
• Build effective relationships with physicians, nursing leaders, clinical departments, community providers, payers, and post-acute organizations.
• Manage the operational relationship with the outsourced revenue cycle and utilization management partner, serving as an accountable liaison and intermediary.
• Lead performance improvement initiatives, care pathways, referral processes, scorecards, data analysis, and evidence-based practices.
• Develop department budgets, manage resources, and support alternative care delivery and reimbursement models.
• Provide education to leadership, medical staff, residents, and care management personnel.
• Evaluate and recommend health information technology improvements supporting care coordination and documentation.

Requirements

• Bachelor’s degree in a related field and a master’s degree required; a master’s in healthcare administration is preferred.
• Current or pending Connecticut Registered Nurse, Social Work, or Nurse Practitioner license; an RN background is strongly preferred. Licensed Master Social Workers may be considered.
• Certified Case Manager certification or certification in a related care management discipline.
• Minimum five years of recent experience in complex hospital-based case management, utilization management, disease management, or related care management.
• Demonstrated leadership experience managing managers and multidisciplinary teams.
• Experience with personnel management, budgeting, performance improvement, CMS and The Joint Commission measures, and healthcare data analysis.
• Strong knowledge of inpatient operations, care transitions, utilization management, social work, and community-based care.
• Excellent communication, interpersonal, public speaking, decision-making, and organizational skills.
• Proficiency with Microsoft Office, Microsoft Excel, and health information technology.
• Experience collaborating with physicians, nurses, payers, and outsourced vendors; RAC certification or eligibility is preferred.
• Consistent onsite presence in the hospital is required; remote candidates will not be considered.

Salary: The posted range is not a guarantee. The actual salary will be based on qualifications, experience, and education and could fall outside of this range. Contact us for more information.
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