About this opportunity
Veracity lists this Director Case Management opportunity in detroit, Michigan. Review the employer’s description below for duties, qualifications and application requirements.
Job description
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
Strong leadership, operational, and communication skills
Preferred Qualifications
Master's Degree in: Nursing, Business Administration, Hospital Administration
Accredited Case Manager (ACM) certification
McKesson InterQual® experience
Business planning experience
Experience within Level I Trauma or large acute care hospital environments
Core Skills
Hospital Case Management
Utilization Management
Transition Management
Care Coordination
Denial Prevention
Patient Throughput Optimization
Revenue Cycle Collaboration
CMS & TJC Compliance
InterQual Reviews
Physician Education
Acute Care Operations
Team Leadership & Staff Development
Worksite address
detroit, MI, 48228, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.