Director of Case Management

We are seeking a dynamic and experienced Director of Case Management to lead our hospital's case management program. This leadership role is responsible for overseeing case managers and social workers while ensuring excellent patient care, compliance with regulatory standards, and efficient utilization of hospital resources. The ideal candidate will have a strong background in inpatient case management, utilization review, discharge planning, and performance improvement initiatives.

Key Responsibilities:

• Lead, supervise, and provide guidance to Case Managers and Social Workers in daily workflow and patient care coordination.
• Ensure documentation meets regulatory compliance and hospital standards.
• Collaborate with the CFO and Quality Department to monitor quality improvement programs, reduce avoidable days, and minimize readmissions.
• Maintain hands-on skills to provide coverage for patient caseloads when needed.
• Coordinate with physicians on patient care plans, level of care, and bed placement assignments.
• Oversee all personnel actions, including hiring, performance appraisals, scheduling, and payroll management through KRONOS.
• Facilitate daily multidisciplinary rounds to ensure holistic, patient-centered care.
• Participate in discharge planning, providing education and resources to patients and families.
• Serve on the Utilization Review and Revenue Recycle Committees.
• Promote efficient utilization of clinical resources and ensure care aligns with patient acuity.
• Ensure compliance with Joint Commission, CMS, state, and local regulations, as well as internal policies and professional standards.
• Perform other duties as assigned to support hospital operations and patient care excellence.

Qualifications:

Education & Certification:

• A graduate of a Registered Nursing program is required.
• Bachelor of Science in Nursing (BSN) preferred.
• Current RN license in Iowa or a multistate license valid in Iowa.
• Iowa Mandatory Reporter Child and Dependent Adult Abuse Certificate required.

Experience:

• Minimum 2 years of case management experience in utilization management, discharge planning, or related cost/quality management programs.
• 2-3 years of management experience preferred, including hospital-based nursing experience.

Knowledge, Skills & Abilities:

• In-depth knowledge of Medicare, managed care, and inpatient/outpatient/home health continuum.
• Strong understanding of utilization management, discharge planning, and case management regulations.
• Proven ability to collaborate with healthcare professionals to improve patient outcomes and achieve organizational goals.
• Knowledge of performance improvement concepts and quality management strategies.
• Excellent communication, leadership, and problem-solving skills.
• Ability to work independently while fostering a team-oriented environment.
• Demonstrated success in building effective relationships with physicians and hospital staff.