Case Management Director

Job Description

Location: Rancho Mirage, CA (Greater Palm Springs Area)

We are seeking an experienced Case Management Director to lead hospital-based case management operations, with oversight of utilization review, care coordination, and patient transition planning. This role is responsible for ensuring appropriate resource utilization, supporting revenue cycle integrity, and driving efficient patient throughput while maintaining compliance with regulatory and accreditation standards.

This position requires a strategic leader who can guide interdisciplinary teams, improve operational performance, and support both clinical and administrative outcomes across the organization.

Responsibilities:

• Oversee daily operations of the Case Management Department, ensuring efficient patient throughput and appropriate utilization of hospital resources
• Lead utilization review processes to support medical necessity, reduce denials, and improve reimbursement outcomes
• Direct care coordination efforts to ensure patients receive appropriate care at the right level and in the proper sequence
• Manage transition planning to support timely discharges, reduce readmissions, and enhance patient satisfaction
• Ensure compliance with all applicable state and federal regulations, as well as accreditation standards
• Monitor key performance indicators related to length of stay, denial prevention, and revenue cycle effectiveness
• Develop and implement process improvements using data to enhance utilization and operational performance
• Provide education and feedback to physicians regarding documentation, utilization practices, and patient status
• Support and oversee post-acute care coordination and provider network relationships
• Collaborate with leadership, clinical teams, and support departments to address operational challenges and improve outcomes
• Establish and maintain departmental policies and procedures aligned with regulatory and organizational expectations
• Participate in ongoing performance improvement initiatives and organizational committees

Qualifications:

• Bachelor’s degree in Nursing, Business, or Healthcare Administration required; Master’s degree preferred (MSN, MBA, MHA, or MSW)
• Active RN or LCSW/LMSW license in the state of practice
• Minimum of 3 years of hospital-based case management or healthcare leadership experience required
• Experience in acute care settings required; multi-site or leadership experience preferred
• Strong knowledge of utilization management, care coordination, and discharge planning processes
• Understanding of regulatory standards, accreditation requirements, and revenue cycle processes
• Accredited Case Manager (ACM) certification preferred
• Strong leadership, communication, and organizational skills

Schedule

• Full-time, onsite position
• Standard business hours with occasional need for flexibility based on operational demands

Salary Range: The salary range for this position is approximately $140,000 – $180,000 annually ($67.00 – $86.00 per hour), based on experience and qualifications. Relocation assistance may be available.

Interview Process:

• Selected candidates will participate in a multi-step interview process, including an initial screening with TalentLNX followed by virtual and onsite interviews with hospital leadership.

Equal Opportunity Employer: TalentLNX is committed to equal employment opportunity and prohibits discrimination and harassment of any kind. We are dedicated to building a diverse workforce and fostering an inclusive work environment where all employees and candidates are treated with respect and dignity. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or any other protected status under applicable law. We actively seek to recruit, develop, and retain talented individuals from diverse backgrounds, and we encourage all qualified candidates to apply for our job opportunities.