Executive Director of Care Management

Our client, a leading healthcare organization, is hiring an Executive Director of Care Management. The Executive Director of Care Management will provide strategic and operational leadership across its inpatient care management functions, including RN Case Management, Social Work, Utilization Management, Clinical Documentation Improvement (CDI), Denials & Appeals, and Complex Care.
Reporting directly to the Senior Vice President, Clinical Affairs & Quality and Chief Clinical & Quality Officer, the Executive Director will oversee a multidisciplinary department supporting a 300+-bed hospital with approximately 16,000 annual inpatient discharges and a significant volume of observation and other patient encounters.

Approximately 70% of this role is focused on internal departmental leadership, operational oversight, staff development, and performance management. The remaining responsibilities include cross-functional collaboration, organizational initiatives, payer and revenue cycle partnerships, and relationships with post-acute and community providers.

The Executive Director will serve as a trusted clinical and operational resource, providing knowledgeable, steady leadership to an established team. This position calls for a leader who can build credibility with staff and physicians, exercise independent judgment, maintain strong departmental performance, and identify opportunities for thoughtful, sustainable improvement.

Responsibilities

• Lead daily operations, performance, staffing, development, and accountability for care management and related teams, including managers and multidisciplinary personnel.
• Oversee inpatient care coordination, admission and discharge planning, utilization management, social work, clinical documentation, denial appeals, and transitional care.
• Ensure compliance with regulatory, accreditation, payer, and applicable quality standards.
• Develop strategies to reduce readmissions, improve patient outcomes, enhance patient and family satisfaction, and support value-based care.
• Build effective relationships with physicians, nursing leaders, clinical departments, community providers, payers, and post-acute organizations.
• Manage the operational relationship with the outsourced revenue cycle and utilization management partner, serving as an accountable liaison and intermediary.
• Lead performance improvement initiatives, care pathways, referral processes, scorecards, data analysis, and evidence-based practices.
• Develop department budgets, manage resources, and support alternative care delivery and reimbursement models.
• Provide education to leadership, medical staff, residents, and care management personnel.
• Evaluate and recommend health information technology improvements supporting care coordination and documentation.

Requirements

• Bachelor’s degree in a related field and a master’s degree required; a master’s in healthcare administration is preferred.
• Current or pending Connecticut Registered Nurse, Social Work, or Nurse Practitioner license; an RN background is strongly preferred. Licensed Master Social Workers may be considered.
• Certified Case Manager certification or certification in a related care management discipline.
• Minimum five years of recent experience in complex hospital-based case management, utilization management, disease management, or related care management.
• Demonstrated leadership experience managing managers and multidisciplinary teams.
• Experience with personnel management, budgeting, performance improvement, CMS and The Joint Commission measures, and healthcare data analysis.
• Strong knowledge of inpatient operations, care transitions, utilization management, social work, and community-based care.
• Excellent communication, interpersonal, public speaking, decision-making, and organizational skills.
• Proficiency with Microsoft Office, Microsoft Excel, and health information technology.
• Experience collaborating with physicians, nurses, payers, and outsourced vendors; RAC certification or eligibility is preferred.
• Consistent onsite presence in the hospital is required; remote candidates will not be considered.

Salary: The posted range is not a guarantee. The actual salary will be based on qualifications, experience, and education and could fall outside of this range. Contact us for more information.
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