Director Case Management

At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.

Job Summary

The Director of Case Management provides leadership, strategic direction, and operational oversight for the Case Management department including care coordination, discharge planning, utilization review, clinical intake, and social services. This position ensures quality, cost-effective healthcare delivery, supports compliance with regulatory standards, and promotes positive patient outcomes across the continuum of care. The director works closely with hospital leadership, physicians, payers, and staff to guide patient flow, optimize resource use, and support performance improvement initiatives. 

Essential Functions

• Oversees and directs the daily operations of Case Management including discharge planning, precertification, denials management, and social work functions 
• Develops and implements departmental policies, procedures, and performance standards 
• Coordinates care management and discharge planning to support quality outcomes and resource efficiency 
• Partners with interdisciplinary teams and external agencies to plan and manage complex patient care transitions 
• Evaluates the effectiveness of care coordination programs and services 
• Ensures compliance with CMS, Joint Commission, and other regulatory agencies 
• Supports strategic initiatives and continuous quality improvement efforts 
• Prepares departmental budgets, monitors financial performance, and manages staffing 
• Participates in executive rounds, hospital committees, and quality improvement programs 
• Leads staff recruitment, training, mentorship, evaluation, and retention strategies 

Knowledge/Skills/Abilities/Expectations

• Strong clinical knowledge of hospital care delivery systems 
• Familiarity with payer guidelines, regulatory requirements, and case management best practices 
• Advanced skills in communication, team leadership, and collaboration 
• Ability to analyze data and implement strategies based on metrics 
• Proficient in MS Office applications and EHR platforms 
• Able to work in a high-stress, fast-paced environment with minimal supervision 
• Demonstrates professional integrity, compassion, and commitment to excellence 
• Populations Served: Care provided to neonate, infant, child, adolescent, adult, and geriatric patient populations 
• Frequent sitting, keyboarding, walking, and standing 
• Occasional lifting, reaching, bending, and pushing/pulling up to 50 lbs 
• Exposure to biohazards, airborne pathogens, and chemical agents in clinical environments 

Education

• Graduate of an accredited school of nursing (Required) Bachelor’s degree in Nursing or related field (Required; must be obtained within 18 months of hire)
• Master’s degree in Nursing, Healthcare Administration, or related field (Preferred) 

Licenses/Certifications

• Current Registered Nurse (RN) license in practicing state or compact license  

Experience

• Minimum of five (5) years of clinical experience in an acute care setting
• Three (3) or more years of leadership experience in case management or a related field