Director, Case Management

Director, Case Management Grants, NM $135,000

• $160,000 a year
• Full-time $135,000
• $160,000 a year
• Full-time We are in search of a Director of Case Management for a Critical Access hospital located in Gallup NM.

Qualifications for

Director of Case Management :

Must-Haves Graduate of a program of Registered Nursing. Minimum of two years of Case Management experience in utilization management, case management, discharge planning, or other cost/quality management program. Current RN license in the state of NM or a multistate license allowing to work in the state of New Mexico. Overview Director of Case Management We are seeking a highly experienced and dynamic Director of Case Management to lead our multidisciplinary team in delivering exceptional patient care across various healthcare settings. This leadership role requires a comprehensive understanding of hospital operations, clinical workflows, and regulatory standards. The ideal candidate will possess extensive management experience, clinical expertise, and a strong commitment to improving patient outcomes through effective case management strategies. The Director will oversee discharge planning, utilization review, medical records review, and ensure compliance with

HIPAA, NCQA

standards, and Medicare regulations. This position offers an opportunity to influence organizational excellence and patient-centered care at a high level. Responsibilities for

Directror of Case Management:

Lead and supervise the case management team, including social workers, nurses, and behavioral health specialists, ensuring efficient coordination of patient care services. Develop and implement care plans tailored to individual patient needs, integrating behavioral health, medical treatment, and discharge planning. Oversee utilization review processes to ensure appropriate resource utilization while maintaining compliance with NCQA standards and Medicare guidelines. Coordinate with hospital departments such as ICU, PICU, emergency medicine, hospital medicine, pediatrics, and Level I & II trauma centers to facilitate seamless patient transitions. Ensure accurate documentation review and data collection for quality assurance and regulatory reporting purposes. Maintain knowledge of HIPAA regulations to safeguard patient information across all case management activities. Conduct regular audits of medical records and documentation to ensure adherence to legal and organizational standards. Lead efforts in behavioral health assessments and mental health counseling integration within case management protocols. Collaborate with physicians, nurses, social workers, addiction counselors, and other healthcare professionals to optimize care plans. Drive continuous improvement initiatives aligned with NCQA accreditation standards and managed care best practices. Provide leadership in discharge planning processes that promote safe transitions from hospital to home or other care facilities. Experience Extensive hospital experience with a strong background in nursing or clinical practice within acute care environments such as ICU, emergency medicine, or trauma centers (Level I & II). Proven management or supervisory experience leading multidisciplinary healthcare teams in complex settings including home health or hospice care. Familiarity with behavioral health services, mental health counseling, addiction counseling, and behavioral therapy modalities. Knowledge of medical terminology, physiology, anatomy, and patient assessment techniques essential for effective case management. Experience working within managed care frameworks including Medicare regulations and NCQA standards. Demonstrated ability to handle data collection processes accurately while ensuring compliance with HIPAA regulations. Strong leadership skills with a track record of supervising staff performance and fostering professional development in healthcare teams. This role is ideal for a strategic leader committed to advancing patient-centered care through expert case management practices in a fast-paced healthcare environment.

Keywords:

care manager, case manager, case management,care management,utilization review, performance safety,RN,Registered nurse,

Pay:

$135,000.00

• $160,000.

00 per year

Benefits:

401(k) Dental insurance Flexible schedule Health insurance Vision insurance

Education:

Associate (Required)

Experience:

Case management: 3 years (Required)

License/Certification:

IA RN License or eligibility (Required)

Work Location:

In person