Director of Case Management - Care Management
Job Summary
Do you have experience reducing LOS?
The Director of Case Management is a critical leadership role that provides strategic leadership for utilization management, transition planning, and patient throughput. This role drives operational efficiency and regulatory compliance (CMS) while collaborating with executive leadership and physician advisors to meet financial and quality benchmarks.
Key Areas Of Responsibility
• Strategic Throughput & LOS: Lead initiatives to reduce Average Length of Stay (ALOS) by identifying systemic bottlenecks and implementing proactive discharge planning.
• Utilization & Revenue Integrity: Oversee the UM Plan to ensure compliance with CMS and payer requirements; manage the peer-to-peer review process and concurrent denial mitigation to protect hospital revenue.
• Operational Leadership: Direct daily operations, staffing, and budgeting for a multidisciplinary team of RN Case Managers and Social Workers
• Interdisciplinary Collaboration: Partner with the CMO, CNO, and CFO to align case management with clinical and financial objectives; lead action-oriented multidisciplinary rounds (MDR).
• Data-Driven Improvement: Analyze KPIs, including readmission rates, cost per case, and bed occupancy, to implement continuous quality improvement strategies.
• Succession Planning & Talent Development: Proactively identify and mentor high-potential staff to build a robust leadership pipeline. Develop formal cross-training programs and professional development pathways for RN Case Managers and Social Workers to ensure operational continuity and internal promotion readiness.
#READ
Qualifications
Education
• BSN or MSW required. MSN, MBA, or MHA preferred.
Licensure
• Active Pennsylvania RN or LCSW/LMSW license
Certifications
• ACM or CCM strongly preferred. If not certified at time of hire, certification should be obtained within a defined period in accordance with organizational expectations.
Experience And Skills
• Extensive leadership experience in and expert knowledge of hospital-based case management, care management, utilization management, discharge planning, social work, patient throughput, transition management, or related area
• Demonstrated experience leading interdisciplinary teams in an acute care setting
• Demonstrated experience with utilization review, medical necessity, patient status, denial prevention, discharge planning, care transitions, payer requirements, and post acute coordination
• Demonstrated experience using operational, clinical, financial, and quality data to drive performance improvement
• Strong knowledge of reimbursement methodologies, managed care principles, payer requirements, Medicare, Medicaid, denial prevention, appeals, and patient status determination
• Strong understanding of the Centers for Medicare & Medicaid Services Conditions of Participation, utilization review requirements, discharge planning regulations, and applicable accreditation standards, including The Joint Commission
• Strong understanding of value-based care, population health, readmission reduction strategies, post acute resource management, and total cost of care
• Knowledge of social determinants of health and the clinical, psychosocial, financial, and operational factors that affect progression of care and safe transitions
• Excellent communication, collaboration, conflict resolution, and relationship-building skills
• Strong leadership, change management, and team development skills
• Strong analytical skills with ability to interpret performance data, identify trends, and implement sustainable improvement strategies
• Ability to develop effective working relationships with physicians, physician advisors, nursing leaders, ancillary departments, community agencies, and payers
• Proficiency with electronic medical records, case management information systems, throughput tools, and reporting platforms
Discover why our hospital is a great place to work—take a virtual tour of Reading Hospital here: https://youtu.be/hH6ItnuIIsc
Overview
Tower Health, a regional healthcare system, serves communities across multiple counties in Pennsylvania. Its network includes Reading Hospital, Phoenixville Hospital, Pottstown Hospital, and St. Christopher's Hospital for Children (in partnership with Drexel University). Committed to academic medicine and training, Tower Health offers various programs, including residency and fellowship programs, the Drexel University College of Medicine at Tower Health, and the Reading Hospital School of Health Sciences. Additionally, the system provides a wide range of healthcare services, such as Reading Hospital Rehabilitation at Wyomissing, home healthcare via Tower Health at Home, TowerDirect ambulance and emergency response, Tower Health Medical Group, Tower Health Providers (a clinically integrated network), and Tower Health Urgent Care facilities across its service area.
Why Reading Hospital?
• 2022-2026: America’s 50 Best Hospitals Award
• Recipient of Excellence Award: Stroke Care, Neurosciences, Pulmonary Care, and Critical Care
• Magnet Status
• Level 1 Trauma Center
• Ranked Among Top Ten Hospitals in Pennsylvania
• 5-Star Rating for Overall Hospital Quality
• Vizient Graduate Nurse Residency Program for all new RN grads
• Comprehensive benefits to include earned time off, enhanced tuition assistance, retirement savings with employer match and so much more!
Hospitals and Health Care
Health Care Provider
Full-time