What are the responsibilities and job description for the Director of Case Management (RN) position at Top Tier Reps LLC?
We are seeking an experienced and strategic Director of Case Management to lead our care coordination and discharge planning efforts. This leadership role is responsible for overseeing all aspects of case management, utilization review, and social services to ensure high-quality, cost-effective care across the continuum. The ideal candidate is a results-driven leader who excels at building interdisciplinary relationships and driving outcomes in a fast-paced healthcare environment.
Key Responsibilities
- Provide leadership and oversight for case management, discharge planning, and social work teams
- Develop and implement strategies to ensure effective utilization review, length of stay management, and care transitions
- Monitor regulatory compliance, accreditation standards, and internal policies related to case management and discharge planning
- Collaborate with physicians, nursing, and other departments to support patient-centered care and appropriate resource utilization
- Analyze data, generate reports, and present key metrics to executive leadership
- Foster professional development and ongoing education for department staff
- Serve as a liaison between the hospital, payers, community agencies, and post-acute providers
Required Qualifications
- Bachelor's degree in Nursing, Social Work, or a related field (Master’s preferred)
- Current RN or LMSW/LCSW license in [Insert State]
- 5 years of case management experience in an acute care setting, including at least 2 years in a leadership role
- Deep understanding of case management processes, discharge planning, and payer requirements
- Strong interpersonal, organizational, and communication skills
- Working knowledge of CMS regulations, InterQual/MCG guidelines, and EMR systems
Preferred Qualifications
- Master’s degree in Nursing, Healthcare Administration, Social Work, or a related field
- ACM (Accredited Case Manager) or CCM (Certified Case Manager) certification
- Experience managing large, multidisciplinary teams
- Familiarity with Lean, Six Sigma, or other process improvement methodologies
Salary & Benefits
- Competitive salary based on experience and qualifications
- Comprehensive benefits package, including:
- Medical, dental, and vision coverage
- Paid time off (PTO), holidays, and sick leave
- 401(k) with employer match
- Tuition reimbursement and continuing education support
- Leadership development programs
- Relocation assistance (if applicable)
Salary : $93,000 - $126,000
