Care Management Director

Medix; Phoenix (AZ); On-site; USD 95,000 - 130,000; Full time

Job summary

Medix is seeking a Care Management Director in Phoenix, AZ, to provide strategic direction and operational oversight for enterprise-wide Care Coordination including Inpatient Care Management, Utilization Management, and Social Work.

The role requires 10+ years in Case Management or Social Work, with 5+ years in leadership in an acute care setting; pediatric experience is preferred and expertise in revenue cycle and coding is essential.

Qualifications

• Required: Bachelor's degree in Nursing, Social Work, Healthcare Administration, Public Health, or related field.
• Preferred: Master's degree in Nursing, Management, Organizational Development, Healthcare Administration, or Social Work.

Responsibilities

• Strategic Leadership & Compliance: Partner with executive leadership to set KPIs and direct operations for Case Management, Utilization Management, and Social Work to ensure EMTALA and evidence-based practices.
• Operational Oversight & Quality: Assess efficiency, establish control mechanisms for scheduling, verifications, and financial clearances; drive quality improvements.
• Financial & Resource Management: Manage budgets; analyze metrics; evaluate technologies to improve care delivery and vendor partnerships.
• Interdisciplinary Collaboration: Coordinate with Nursing, Managed Care, Revenue Cycle, HIM, and Medical Group leadership to streamline transitions.
• Team Development & Mentorship: Build a high-performing team with clear expectations and targeted education.

Skills

Leadership

Case Management

Social Work

Cross-functional collaboration

Education

Bachelor's degree

Master's degree

Tools

MCG

InterQual

Allscripts Care Management (ACM)

Milliman guidelines

Job description

Care Management Director (258392) Paradise Valley, Arizona

Salary: USD95000 - USD130000 per year

Director of Care Management & Social Work

Location: Phoenix, AZ

POSITION SUMMARY We are seeking an experienced healthcare executive to provide strategic direction, overall leadership, and operational oversight for our enterprise-wide Care Coordination departments, including Inpatient Care Management, Utilization Management, and Social Work.

This role serves as a key operational pillar—ensuring close alignment between care coordination and nursing leadership, developing family-centered care management models, and implementing population health initiatives. The leader will oversee vendor relationships, drive transition-to-care navigation programs, improve clinical outcomes through clinical innovation, and manage utilization to support cost-effective, high-quality pediatric care.

KEY RESPONSIBILITIES

• Strategic Leadership & Compliance: Partner with executive leadership to establish clinical and financial Key Performance Indicators (KPIs). Direct day-to-day operations for Case Management, Utilization Management, and Social Work to ensure full compliance with EMTALA, legal standards, and evidence-based clinical practices.
• Operational Oversight & Quality: Evaluate operational efficiency, establishing robust control mechanisms for hospital scheduling, insurance verifications, and financial clearances. Lead continuous quality improvement initiatives across all assigned units.
• Financial & Resource Management: Formulate and manage departmental operating budgets. Analyze operational and financial metrics, evaluate emerging technologies to streamline care delivery, and manage external vendor partnerships.
• Interdisciplinary Collaboration: Maintain active collaboration with Nursing, Managed Care, Revenue Cycle, Health Information Management (HIM), and Medical Group leadership to streamline care transitions and resolve complex cross-departmental bottlenecks.
• Team Development & Mentorship: Build a high-performing team by fostering professional growth, establishing clear performance expectations, and facilitating targeted education and training opportunities.

QUALIFICATIONS & REQUIREMENTS

Education

• Required: Bachelor’s degree in Nursing, Social Work, Healthcare Administration, Public Health, or a related field (or an equivalent combination of education and experience).
• Preferred: Master’s degree in Nursing, Management, Organizational Development, Healthcare Administration, or Social Work.

Experience

• 10+ years of progressive experience in Case Management or Social Work.
• 5+ years of leadership experience in an acute care hospital environment.
• 5+ years leading cross-functional departments supporting patient/family resources, community alignment, and/or utilization management (e.g., Social Work, Financial Counseling, Case Management).
• Pediatric acute care experience is highly preferred.

Technical Skills & Expertise

• Required: Strong understanding of revenue cycle operations at the clinical/financial intersection; working knowledge of third-party reimbursement models, patient access, financial clearance, and ICD-9/ICD-10 coding; proficiency with MCG and InterQual criteria.
• Preferred: Deep familiarity with Milliman guidelines and Allscripts Care Management (ACM).
• Core Competencies: Exceptional analytical, problem-solving, and conflict-resolution skills; proven ability to influence and lead cross-functional teams; strong computer literacy.

Certifications & Credentials

• Required: Valid Arizona Department of Public Safety (DPS) Fingerprint Clearance Card.
• Preferred: Active State of Arizona RN License (or compact state equivalent with multi-state privileges).
• Preferred: National certification in Case Management (CCM), Social Work (LCSW), or equivalent credential.