Director Inpatient Care Management

Job Title: Director Inpatient Care Management
Location: Concord, NH

Job Description:
We are seeking an experienced Director of Inpatient Care Management to provide strategic and operational leadership for care management, utilization management, discharge planning, transitions of care, and population health initiatives across a multi-hospital health system.

This leader will be responsible for ensuring regulatory compliance, optimizing resource utilization, improving patient outcomes, reducing avoidable readmissions, and supporting financial performance through effective utilization review and care coordination practices.

The Director will collaborate closely with executive leadership, physicians, nursing leaders, case managers, social workers, revenue cycle teams, and community partners to ensure patients receive the appropriate care in the right setting at the right time.

Key Responsibilities:

• Develop and implement a system-wide vision, strategy, and operational plan for Care Management and Utilization Review.
• Standardize care management and utilization review processes across hospitals and care settings.
• Lead initiatives focused on improving quality outcomes, patient experience, patient throughput, length of stay, and cost-effective care delivery.
• Support organizational goals related to value-based care, population health, and regulatory compliance.
• Direct inpatient and outpatient care management services, including case management, social work, discharge planning, and care coordination.
• Ensure timely and effective patient assessments, care planning, and transition-of-care activities.
• Promote interdisciplinary collaboration to address clinical, psychosocial, and financial barriers to care.
• Develop and implement programs designed to reduce readmissions and improve post-acute care transitions.
• Oversee utilization review processes to ensure appropriate level-of-care determinations and compliance with payer requirements.
• Monitor medical necessity reviews and authorization processes.
• Collaborate with physicians and clinical documentation teams to support accurate patient status determinations.
• Lead denial prevention and appeals strategies to minimize revenue loss and improve reimbursement.
• Analyze utilization, length-of-stay, and other performance data to identify opportunities for improvement.
• Drive process improvement initiatives related to utilization management, denial prevention, throughput, and care transitions.
• Ensure compliance with CMS Conditions of Participation, Joint Commission standards, state regulations, and payer requirements.
• Maintain organizational readiness for regulatory surveys, audits, and accreditation reviews.
• Provide strategic leadership, mentorship, and professional development for care management staff.
• Establish performance expectations and promote accountability, collaboration, and continuous improvement.
• Monitor department performance and implement corrective strategies when necessary.
• Perform other duties and responsibilities as assigned.

Education:

• Bachelor's degree in Nursing required.
• Master's degree in a health-related or science field required.
• Licensure & Certification:
• Current and active Registered Nurse (RN) license in New Hampshire required.
• Certified Case Manager (CCM), Accredited Case Manager (ACM), or related certification strongly preferred.

Experience:

• Minimum of 7 10 years of progressive leadership experience in Care Management, Case Management, Utilization Review, or Population Health.
• Minimum of 5 years of management experience within a hospital or integrated health system.
• Experience overseeing multi-site or multi-hospital operations preferred.
• Demonstrated success in utilization management and healthcare process improvement.
• Experience with denial prevention, throughput improvement, care transitions, and utilization review preferred.
• Strong understanding of hospital operations, payer requirements, and regulatory standards.

Skills & Competencies:

• Strong strategic and operational leadership skills.
• Excellent communication and interpersonal abilities.
• Strong knowledge of care management and utilization review practices.
• Ability to analyze healthcare data and develop performance improvement strategies.
• Strong understanding of regulatory and payer requirements.
• Ability to collaborate effectively with physicians, nurses, executives, clinical teams, and external partners.
• Strong problem-solving, decision-making, and organizational skills.
• Ability to lead teams through change and continuous improvement initiatives.
• Commitment to quality, patient safety, and patient-centered care.

Physical & Work Requirements:

• The physical requirements of this position include:
• Regularly performing fine motor activities, hearing, speaking, and walking.
• Frequently bending, reaching, sitting, squatting, and standing.
• Occasionally climbing, kneeling, performing repetitive motions, and other physical activities as required.
• Ability to regularly lift, carry, or push/pull up to 10 pounds; frequently handle 10 25 pounds; and occasionally handle 20 50 pounds.
• Specific vision abilities include color vision, depth perception, far vision, near vision, and peripheral vision.
• Frequent exposure to airborne pathogens, bloodborne pathogens, and bodily fluids.
• Occasional exposure to airborne contaminants, chemotherapeutic agents, electrical hazards, moving mechanical parts, temperature variations, slippery surfaces, and toxic or caustic chemicals.
• Work environment generally has a moderate noise level.
• Reasonable accommodations may be provided to enable qualified individuals with disabilities to perform essential functions.