Director Case Management

Benefits:

401(k)

401(k) matching

Dental insurance

Health insurance

Relocation bonus

Director Case Management

Location: Detroit, MI Job Type: Full-Time

Work Model: Onsite

The Director Case Management is responsible for overseeing utilization management, transition management, care coordination, compliance, and operational leadership of the hospital’s Case Management Department.

This leadership role drives hospital utilization performance improvement, denial prevention, patient throughput efficiency, regulatory compliance, and reimbursement optimization. The ideal candidate will possess strong acute hospital case management leadership experience with expertise in utilization review, payer management, care coordination, and interdisciplinary collaboration.

Work Environment

Hospital-based leadership role within a Level I Trauma Center

Fast-paced acute care environment

Collaboration with physicians, nursing leadership, finance, revenue cycle, ancillary teams, and executive leadership

Oversight of utilization management, transition planning, compliance, and care coordination

Data-driven operational improvement environment

Key Responsibilities

Department Operations & Leadership

Lead and oversee daily operations of the Case Management Department

Ensure effective patient throughput and reimbursement optimization

Maintain adequate staffing and skill mix across 7-day operations

Conduct staff competency evaluations and performance reviews

Lead departmental meetings, education sessions, and operational initiatives

Utilization Management

Implement and oversee the hospital Utilization Management Plan

Ensure accurate and timely medical necessity reviews in compliance with CMS and organizational policies

Monitor payer communications, authorizations, denials, and peer-to-peer review processes

Analyze Avoidable Days and utilization trends to drive performance improvement

Participate in Revenue Cycle and Medicare Performance Improvement initiatives

Transition Management & Care Coordination

Ensure timely transition planning assessments within 24 hours of admission

Monitor patient placement and discharge planning workflows

Support efficient sequencing of consults, procedures, and care delivery

Lead Complex Case Review and Patient Care Conference processes

Collaborate with interdisciplinary teams to optimize patient outcomes and throughput

Compliance & Regulatory Oversight

Ensure compliance with:

CMS Conditions of Participation

TJC Accreditation Standards

Federal and state regulations

Organizational policies

Implement and monitor compliance with Tenet Case Management practices

Support internal and external audit readiness activities

Education & Physician Engagement

Provide physician education regarding:

Medical necessity

Documentation accuracy

Regulatory compliance

Utilization performance

Educate case management staff and healthcare teams on progression of care and transition planning best practices

Must-Have Qualifications

Bachelor’s Degree in:

Nursing

Healthcare-related field OR

Master’s Degree in Social Work (MSW)

Active RN or LCSW/LMSW license

Minimum 3–5 years of acute hospital case management leadership experience

Strong experience with:

Utilization Management

Transition Management

Care Coordination

Denial Prevention

Patient Throughput

Revenue Cycle collaboration

Strong understanding of:

CMS Regulations

TJC Standards

Case Management compliance