Director, Unified Case Management & Utilization

Nexus Health Systems; Houston (TX); On-site; USD 180,000 - 240,000; Full time

Benefits offered by this job

Competitive compensation

Comprehensive benefits

Job summary

Nexus Health Systems in Houston seeks an experienced Corporate Director of Case Management & Utilization Review to lead system-wide operations, align clinical and financial goals, and drive high-quality, efficient patient care. The role requires strong leadership across Case Management and UR, expertise in medical necessity review, discharge planning, and performance improvement across multiple facilities.

You will partner with physicians and revenue cycle leaders to optimize outcomes and

Qualifications

• Seven+ years of progressive hospital case management leadership and UR oversight.
• Experience standardizing operations across multiple facilities.
• Strong expertise in medical necessity, payer requirements, and discharge planning.

Responsibilities

• Provide strategic direction for system-wide case management and UR.
• Lead care coordination, discharge planning, and transitions of care.
• Develop standardized workflows, policies, and performance metrics.
• Monitor denial prevention and utilization trends with leadership teams.
• Oversee budgets, staffing, and resource allocation.

Skills

Strategic leadership

Cross-functional leadership

Clinical analytics

Change management

Communication

Education

BSN

MSN

Case management certification

Tools

InterQual® criteria

EHR systems

Job description

Nexus Health Systems in Houston seeks an experienced Corporate Director of Case Management & Utilization Review to lead system-wide operations, align clinical and financial goals, and drive high-quality, efficient patient care. The role requires strong leadership across Case Management and UR, expertise in medical necessity review, discharge planning, and performance improvement across multiple facilities.

You will partner with physicians and revenue cycle leaders to optimize outcomes and