Title: Director of Case Management
Level: Mid-Level
Location: Rutherfordton, NC (On-Site)
Travel: Not required
Visa Support: Not available
Relocation Support: Full
Compensation: $102,000 - $145,000 per year
Sign-On Bonus: Negotiable
Position Overview
The Director of Case Management is responsible for overseeing case management functions, including clinical resource management, discharge planning, patient advocacy, and medical necessity determination. This role ensures that care management aligns with utilization review plans and regulatory standards, while optimizing patient outcomes and hospital resources.
Key Responsibilities
Lead and manage case management operations, ensuring effective planning, staffing, and performance improvement initiatives.
Oversee care coordination in alignment with hospital policies, medical group requirements, and state/federal regulations.
Collaborate with physicians, administrators, and healthcare teams to enhance care management and streamline patient transitions.
Develop departmental goals and objectives that support the hospital's strategic plan.
Ensure compliance with payer requirements, regulatory agencies, and care management standards (Joint Commission, CMS, AHCA, etc.).
Educate and mentor staff on utilization review processes, length of stay (LOS) standards, and regulatory requirements.
Optimize resource utilization and reimbursement processes to enhance hospital efficiency and financial performance.
Lead efforts to improve care coordination across the healthcare continuum.
Must-Have Qualifications
Associate’s Degree in Nursing (ADN) required
Current RN license in North Carolina (or multi-state compact license)
BLS Certification required
CCM Certification (must be obtained within the first year of employment)
Nice-to-Have Qualifications
Bachelor’s Degree in Nursing (BSN) or Master’s Degree in a related field
ACMA Certification preferred
Required Experience & Skills
3+ years of RN experience in acute care and/or care coordination
3+ years of management experience preferred
Strong knowledge of care management, discharge planning, Medicare/Medicaid regulations, and payer requirements
Experience with Interqual criteria, finance/budgeting, and government billing regulations
Excellent communication and leadership skills, with the ability to educate and mentor staff
Strong analytical and problem-solving abilities in a fast-paced healthcare environment
Why Join Us?
Comprehensive Benefits: Medical, dental, vision, and 401(k)
Paid Time Off & Extended Illness Bank
Tuition Reimbursement & Professional Development opportunities
Leadership Role in a highly respected healthcare organization