Clinical Director, Case Management & Utilization

Confidential; New Jersey; On-site; USD 110,000 - 160,000; Full time

Job summary

Confidential is seeking a senior leader to mentor Social Workers and Case Managers within the Case Management Department. The role focuses on utilization review, discharge planning, and maintaining regulatory compliance across CMS guidelines.

The successful candidate will act as a clinical expert, conduct second-level determinations, collaborate with medical staff, and drive process improvements to ensure high-quality patient care and timely dispositions.

Qualifications

• Knowledge of Utilization Review criteria and discharge planning and length of stay initiatives.
• Knowledge in Medicaid, Medicare, Managed Care review and documentation requirements; familiarity with state and federal regulations, DNV standards for acute care facilities.

Responsibilities

• Mentor and oversee Social Workers and Case Managers; assist daily operations of Case Management Department.
• Conduct 2nd level status determinations and medical necessity reviews as requested by case managers.
• Educate physicians on appropriateness of level of care and timely discharge planning.
• Coordinate with medical staff to resolve utilization management issues and ensure optimal patient outcomes.
• Comply with CMS Hospital conditions of participation for Utilization Review and applicable regulatory requirements.
• Develop processes with administration to improve quality of care and electronic documentation.

Skills

Utilization review knowledge

Discharge planning

Regulatory compliance

Education

Nursing or Medical degree

NJ license

Job description

Confidential is seeking a senior leader to mentor Social Workers and Case Managers within the Case Management Department. The role focuses on utilization review, discharge planning, and maintaining regulatory compliance across CMS guidelines.

The successful candidate will act as a clinical expert, conduct second-level determinations, collaborate with medical staff, and drive process improvements to ensure high-quality patient care and timely dispositions.