Director of Case Management

Director of Case Management

Locations: Detroit, MI | Worcester, MA | Memphis, TN

Employment Type: Full-Time | Direct Hire

Compensation: $103,000 – $183,000 annually (based on location and experience)

Relocation Assistance: Available based on candidate location and distance

Position Overview

Wheeler Staffing Partners is seeking experienced Directors of Case Management for multiple acute care hospital leadership opportunities across Detroit, MI, Worcester, MA, and Memphis, TN.

These leadership roles are responsible for overseeing hospital utilization management, care coordination, transition planning, patient throughput, and operational management of the Case Management Department. The Director of Case Management will lead initiatives that support appropriate reimbursement, optimize resource utilization, reduce avoidable days, improve patient outcomes, and ensure compliance with all federal, state, and accreditation standards.

The ideal candidate will possess strong acute care hospital case management leadership experience along with expertise in utilization review, discharge planning, denial prevention, regulatory compliance, and interdisciplinary care coordination.

Candidates must possess an active RN or LCSW/LMSW license and prior acute care hospital case management leadership experience.

Key Responsibilities

Case Management Leadership & Operations

• Oversee daily operations of the hospital Case Management Department
• Manage staffing levels, workflow distribution, and departmental productivity across seven-day operations
• Lead onboarding, competency evaluations, performance reviews, and staff development initiatives
• Conduct departmental meetings and ongoing education programs
• Support recruitment, coaching, employee engagement, and performance improvement activities
• Assist with department budgeting, operational planning, and strategic initiatives

Utilization Management

• Oversee utilization review processes to ensure appropriate patient status, level of care, and medical necessity compliance
• Monitor compliance with CMS regulations, accreditation standards, and organizational case management policies
• Lead denial prevention initiatives and payer communication processes
• Monitor throughput metrics, avoidable days, and utilization trends to identify improvement opportunities
• Participate in revenue cycle meetings and reimbursement optimization initiatives
• Support physician advisor reviews and peer-to-peer payer escalations

Transition Planning & Care Coordination

• Ensure transition planning assessments are completed within required timelines
• Support discharge planning and patient placement coordination activities
• Collaborate with physicians, nursing leadership, ancillary departments, and external providers to improve patient throughput
• Monitor care coordination documentation and transition planning compliance
• Participate in bed management and complex case review discussions
• Promote safe, timely, and patient-centered discharge planning practices

Regulatory Compliance & Quality Improvement

• Ensure compliance with federal, state, and accreditation standards impacting case management operations
• Maintain compliance with CMS Conditions of Participation and regulatory requirements
• Support implementation of audit recommendations and quality improvement initiatives
• Develop and maintain departmental policies, procedures, and operational protocols
• Monitor departmental adherence to utilization review procedures and documentation standards

Education & Staff Development

• Provide education to physicians and interdisciplinary teams regarding medical necessity, utilization management, and regulatory compliance
• Lead ongoing staff education related to case management best practices and utilization review standards
• Support training initiatives related to InterQual criteria, documentation standards, and patient throughput processes
• Foster a culture of collaboration, accountability, and continuous improvement

Required Qualifications

Education

• Bachelor’s degree in Nursing, Healthcare Administration, Business, or related healthcare field required
• Master of Social Work (MSW) required for Social Work candidates
• Master’s degree in Nursing, Business Administration (MBA), or Healthcare Administration (MHA) preferred

Licensure

• Active Registered Nurse (RN) license OR active LCSW/LMSW license required

Experience

• 3–5 years of acute care hospital case management leadership experience required
• 5 years of acute hospital case management experience preferred
• Experience with utilization management, denial prevention, discharge planning, care coordination, and patient throughput initiatives required
• InterQual® experience preferred
• Business planning and operational management experience preferred

Preferred Certifications

• Accredited Case Manager (ACM) certification preferred

Required Skills & Competencies

• Strong leadership and team management skills
• Knowledge of utilization management, care coordination, discharge planning, and reimbursement processes
• Strong understanding of CMS regulations, Joint Commission standards, and hospital accreditation requirements
• Excellent communication, presentation, and relationship-building abilities
• Strong analytical, organizational, and problem-solving skills
• Experience managing multiple priorities in a fast-paced acute care hospital environment
• Strong project management and performance improvement capabilities
• Ability to collaborate effectively with physicians, nursing leadership, revenue cycle teams, payers, and interdisciplinary staff
• Experience with EMR training and utilization analytics and reporting tools preferred

Why Work With Wheeler Staffing Partners?

Wheeler Staffing Partners specializes in connecting healthcare professionals with leading hospitals and healthcare organizations nationwide. Our team partners with experienced clinical and operational leaders to support high-quality patient care, operational excellence, and long-term career growth within healthcare leadership.