Director of Care Management & Social Work- 257548

Medix™; Phoenix (AZ); On-site; USD 180,000 - 280,000; Full time

Job summary

Medix™ seeks a seasoned healthcare executive to lead Care Management, Utilization Management, and Social Work in Phoenix, AZ. The role ensures alignment with nursing leadership, develops family-centered care models, and drives population health initiatives across enterprise care coordination.

TheDirector will oversee vendor partnerships, transition-to-care navigation, and outcomes optimization, while managing cost-effective, high-quality pediatric care across departments.

Qualifications

• Bachelor's degree in Nursing, Social Work, Healthcare Administration, Public Health, or related field; equivalent education/experience.
• 10+ years of progressive experience in Case Management or Social Work.
• 5+ years of leadership 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.

Responsibilities

• Provide strategic direction and operational oversight for Case Management, Utilization Management, and Social Work.
• Ensure compliance with EMTALA, legal standards, and evidence-based clinical practices.
• Manage operating budgets and analyze operational/financial metrics.
• Foster interdisciplinary collaboration across Nursing, Managed Care, Revenue Cycle, HIM, and Medical Group leadership.
• Develop and mentor a high-performing team with clear performance expectations.

Skills

Strategic leadership

Analytical skills

Team development

Cross-functional collaboration

Education

Bachelor's degree (Nursing, Social Work, Healthcare Administration, Public Health)

Master's degree preferred

Tools

MCG criteria

InterQual criteria

Allscripts Care Management (ACM)

Milliman guidelines

ICD-9/ICD-10 coding

Job description

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.