Director Case Management

Job Title: Director Case Management
Location: Memphis, TN
Job Type: Full-Time
Work Model: Onsite

The Director of Case Management is responsible for the overall leadership and operational management of hospital case management services, including utilization management, transition management, patient throughput, denial prevention, and compliance oversight.
This leadership role ensures effective utilization of hospital resources, timely and accurate revenue cycle processes, safe patient transitions, and compliance with CMS regulations, TJC accreditation standards, and organizational policies. The ideal candidate will bring strong acute care hospital case management leadership experience with expertise in utilization review, care coordination, and interdisciplinary collaboration.

Work Environment
Hospital-based leadership role
Fast-paced acute care environment
Direct collaboration with physicians, nursing leadership, social work teams, and executive leadership
Oversight of utilization management, care coordination, and transition planning operations
Focus on operational efficiency, compliance, and patient throughput


Key Responsibilities

Case Management Operations
Lead and oversee daily operations of the Case Management Department
Ensure effective patient throughput and coordination of care services
Optimize utilization management and reimbursement processes
Drive denial prevention initiatives and revenue cycle accuracy

Utilization Management & Compliance
Implement and oversee the hospital Utilization Management Plan
Ensure medical necessity documentation aligns with CMS regulations and organizational policies
Maintain compliance with state and federal regulations, TJC standards, and internal policies
Monitor case management performance metrics and drive operational improvements

Transition Management & Care Coordination
Ensure safe and timely patient transitions and discharge planning
Promote appropriate length of stay and readmission prevention strategies
Improve patient satisfaction and continuity of care outcomes
Coordinate interdisciplinary care management activities

Leadership & Physician Collaboration
Educate physicians on utilization management and documentation requirements
Provide ongoing physician feedback related to hospital utilization performance
Lead, mentor, and develop case management staff
Foster collaborative relationships across departments and leadership teams

Must-Have Qualifications

Bachelor's Degree in:
Nursing
Business
Healthcare Administration
OR
Master's Degree in Social Work (for MSW candidates)
Minimum 3 years of acute hospital case management or healthcare leadership experience
Active RN or LCSW/LMSW license
Current licensure in applicable state(s) as required by law or organizational policy
Strong understanding of:
Utilization Management
Care Coordination
Transition Management
Revenue Cycle Processes
CMS Regulations
TJC Accreditation Standards
Strong leadership, operational, and communication skills

Preferred Qualifications
5+ years of acute hospital case management leadership experience
Multi-site healthcare leadership experience
MSN, MBA, MSW, or MHA
Accredited Case Manager (ACM) certification
Strong physician engagement and education experience

Core Skills
Hospital Case Management
Utilization Management
Care Coordination
Transition Management
Revenue Cycle & Denial Prevention
Patient Throughput Optimization
CMS & TJC Compliance
Physician Education
Acute Care Operations
Team Leadership & Staff Development
Regulatory Compliance
Healthcare Administration