Nurse Director of Case Management Utilization Review

Nurse Director of Case Management Utilization Review —ignite an impact-driven leadership career in a high-acuity Southern California hospital . The Nurse Director of Case Management Utilization Review will champion care coordination excellence, operational efficiency, and patient-centered outcomes in a thriving, forward-looking environment.

Why this hospital : The Nurse Director of Case Management Utilization Review will join an organization consistently recognized by national quality benchmarks for patient safety, clinical effectiveness, and experience, with top-tier performance in throughput and readmission reduction. The Nurse Director of Case Management Utilization Review will leverage advanced EHR, real-time analytics, and evidence-based tools to drive utilization management, while benefiting from a culture of continuous improvement, community partnerships, and philanthropy that expands access to care and invests in cutting-edge programs and technologies.

Team, structure, and scope : The Nurse Director of Case Management Utilization Review will report to executive nursing leadership with collaborative alignment to medical leadership and revenue integrity, guiding a talented team of case managers, social workers, and utilization review nurses within a collegial, diverse, and nurse-friendly culture. The Nurse Director of Case Management Utilization Review will own utilization review strategy, denials prevention and management, payer collaboration, InterQual/MCG criteria application, length-of-stay optimization, discharge planning, and care transitions—partnering closely with a physician advisor, hospitalists, surgical services, ED leadership, and ancillary departments to hardwire evidence-based workflows that elevate quality, compliance, and the patient journey.

Southern California lifestyle : The Nurse Director of Case Management Utilization Review will enjoy year-round sunshine, iconic beaches, and quick escapes to mountains and desert parks—surf at sunrise, hike coastal bluffs, or ski weekend slopes—all within reach of world-class concerts, museums, and sporting events. The Nurse Director of Case Management Utilization Review will savor a renowned culinary scene from taco trucks to Michelin-starred dining, vibrant farmers markets, lively cultural districts, and easy access to theme parks, coastal trails, boutique shopping, and dynamic neighborhoods that fit every lifestyle.

Compensation, benefits, and next steps : The Nurse Director of Case Management Utilization Review will be offered a competitive executive salary, performance bonus potential, and relocation assistance, alongside a comprehensive benefits package that includes medical, dental, and vision coverage, retirement savings with employer match, generous paid time off, paid holidays, tuition and certification support (ACM/CCM), CEU reimbursement, life and disability insurance, wellness resources, and employee assistance programs . To explore this role confidentially, the Nurse Director of Case Management Utilization Review can connect with a Clinical Management Consultants recruiter and open the door to a career move that truly matters.