Regional Director of Case Management & Care Coordination

Palmetto-General-Hospital; Florida; On-site; USD 140,000 - 190,000; Full time

Job summary

Palmetto-General-Hospital is seeking a senior leader to oversee Case Management departments across all hospitals, driving utilization performance improvement and compliant processes. The role focuses on standardizing case management workflows, ensuring appropriate reimbursement, and promoting efficient patient throughput.

The position requires a RN license with 5+ years in acute case management, with MSN and ACM preferred.

Qualifications

• Active Registered Nurse license with at least 5 years in acute hospital case management; leadership experience preferred.
• MSN and Accredited Case Manager (ACM) preferred; InterQual experience preferred.
• Strong organizational, verbal and written communication, leadership, critical thinking and problem-solving skills; able to coordinate diverse teams.
• Business planning experience preferred.

Responsibilities

• Oversee Case Management departments across all hospitals to ensure throughput and reimbursement.
• Lead implementation and oversight of Utilization Management Plans using data to drive improvement.
• Ensure medical necessity reviews comply with CMS regulations and HSA policy.
• Ensure timely patient transition and throughput; minimize payer disputes.
• Develop physician education and feedback on hospital utilization.
• Ensure compliance with state/federal regulations and TJC standards.

Education

MSN preferred

ACM preferred

Tools

Allscripts Care Management System

McKesson CERMe InterQual

Crimson

Cerner HPF

Enterprise Reporting

Care Discovery

Position Control

Job description

Palmetto-General-Hospital is seeking a senior leader to oversee Case Management departments across all hospitals, driving utilization performance improvement and compliant processes. The role focuses on standardizing case management workflows, ensuring appropriate reimbursement, and promoting efficient patient throughput.

The position requires a RN license with 5+ years in acute case management, with MSN and ACM preferred.