Job Description
Summary:
The Senior Director of Case Management is responsible for developing, organizing, and managing the operations of the Care Coordination department, with direct supervision of facility-level case management leadership across the MLH system. This position leads and evaluates case management initiatives in collaboration with clinical leadership and social services teams to ensure seamless care transitions, resource optimization, and patient advocacy. Models appropriate behavior as exemplified in MLH Mission, Vision, and Values.
Education/Training & Experience:
Required:
- Master’s degree (minimum) in clinical area or hospital/business administration
- Five (5) years in clinical health care setting, including direct experience in care coordination, discharge planning, patient advocacy, and resource utilization.
- Ten (8) years of progressively responsible and leadership in social work, case management or nursing administrative
- State Licensure for specific specialty (nursing or social work)
- Case Management Certification (CCM or ACMA)
Preferred:
- Work with EPIC EHR
- MCG certification
Knowledge/Skills/Abilities:
- Executive presence and strategic communication skills, with the ability to serve as a trusted advisor to MLH system leadership.
- Deep understanding of regulatory policies, healthcare reform initiatives, patient care delivery models, and advanced care management strategies.
- Proven expertise in clinical data analysis, performance metrics, and outcomes-based research to drive system-wide improvements.
- Exceptional oral and written communication skills, with the ability to influence and collaborate across diverse stakeholder groups.
- Strong working knowledge of financial management, strategic planning, and operational forecasting in a complex healthcare environment.
- Insight into internal and external forces shaping healthcare delivery, including policy, market dynamics, and community needs.
- Extensive knowledge of reimbursement practices, payer regulations, and value-based care models.
- Demonstrated leadership capabilities in coaching, mentoring, and navigating complex organizational challenges with resilience and diplomacy.
- Comprehensive understanding of care management systems, regulatory compliance, and standards of practice in case management and social work.
- Mastery of healthcare management principles, including budgeting, workforce planning, and operational oversight of large-scale clinical programs.
Key Job Responsibilities:
- Leads the strategic design and implementation of system-wide care management programs to ensure optimal clinical and financial outcomes for the MLH patient population.
- Oversees the planning, execution, and continuous improvement of case management and care coordination processes across all MLH facilities.
- Directs system-level initiatives to reduce extended length of stay and improve patient throughput, especially for complex discharge scenarios.
- Champions patient-centered care initiatives that align with MLH’s mission and promote efficient use of clinical resources.
- Serves as a senior advisor to MLH executive leadership on regulatory trends, policy changes, and their impact on care delivery and financial performance.
- Defines and standardizes roles, workflows, and performance expectations for case managers and social workers across the enterprise.
- Develops integrated care coordination models that support seamless transitions of care between inpatient, outpatient, community, and MLH-affiliated entities (e.g., Alliance).
- Collaborates with clinical departments to embed care management principles into service lines and care pathways.
- Leads system-wide planning and response efforts for regulatory audits, ensuring compliance and minimizing financial exposure.
- Partners with Patient Financial Services, Corporate Compliance, and Clinical Operations to enhance revenue cycle performance and care documentation practices.
- Works closely with system finance and contracting teams to evaluate payer agreements and identify opportunities for revenue optimization and care alignment.
Supervision Provided by this Position:
- Manages system utilization review team and facility level case management leadership.
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