Care Management Services Director

Job Summary:
We are seeking an experienced Care Management Services Director to lead and oversee our care management programs. This role is responsible for developing strategies to improve patient outcomes, streamline care coordination, and ensure compliance with healthcare regulations. The ideal candidate will have strong leadership skills, a deep understanding of care management processes, and the ability to collaborate across multiple departments to enhance patient care delivery.

Key Responsibilities:

• Develop and implement care management strategies to improve patient care coordination, reduce readmissions, and enhance quality outcomes.
• Oversee the daily operations of the care management department, including case management, utilization review, and discharge planning.
• Lead and mentor a team of care managers, social workers, and support staff to ensure the delivery of high-quality patient care.
• Collaborate with physicians, nursing staff, and other healthcare professionals to promote seamless transitions of care.
• Ensure compliance with federal, state, and local regulations, as well as accreditation and payer requirements.
• Monitor key performance indicators (KPIs), including length of stay, readmission rates, and utilization management metrics.
• Identify opportunities for process improvement and implement evidence-based best practices.
• Manage departmental budgets and resource allocation to align with organizational goals.
• Develop partnerships with community resources, post-acute care providers, and insurance companies to optimize patient care pathways.

Qualifications:

• Education: Bachelor’s degree in Nursing, Social Work, or a related healthcare field required; Master’s degree preferred.
• Licensure/Certification: Active RN, LCSW, or related healthcare license required. Certified Case Manager (CCM) preferred.
• Experience: Minimum of 5 years of care management experience in a healthcare setting, with at least 2 years in a leadership role.
• Strong knowledge of care coordination, utilization review, discharge planning, and population health management.
• Excellent leadership, communication, and problem-solving skills.
• Experience with data analysis and performance improvement initiatives.