Regional Director of Case Management & Utilization

Palmetto General Hospital; Florida; On-site; USD 120,000 - 160,000; Full time

Job summary

Palmetto General Hospital is seeking a Director of Case Management to oversee the Case Management Departments across HSA hospitals, driving utilization performance, throughput efficiency, and compliant reimbursement strategies.

The role requires an active RN license with 5+ years in acute hospital case management; MSN and ACM preferred. Qualified candidates will lead a multidisciplinary team and ensure education for physicians and staff.

Qualifications

• Active RN license required.
• 5+ years acute hospital case management experience.
• MSN preferred; ACM preferred.
• InterQual experience preferred and knowledge.
• Strong organizational, verbal and written communication skills.

Responsibilities

• Oversee Case Management operations across HSA hospitals to ensure throughput and reimbursements.
• Lead Utilization Management initiatives using data to drive performance improvements.
• Ensure CMS regulatory compliance and adherence to TJC standards.
• Develop physician education and feedback on hospital utilization.

Skills

Organizational skills

Verbal & written communication

Leadership

Critical thinking

Problem solving

Computer literacy

Business planning

Education

RN license

MSN preferred

ACM preferred

InterQual knowledge

Tools

Allscripts Care Management System

McKesson CERMe InterQual

Crimson

Cerner

HPF

Enterprise Reporting (Decision Support)

Care Discovery

Position Control

Job description

Palmetto General Hospital is seeking a Director of Case Management to oversee the Case Management Departments across HSA hospitals, driving utilization performance, throughput efficiency, and compliant reimbursement strategies.

The role requires an active RN license with 5+ years in acute hospital case management; MSN and ACM preferred. Qualified candidates will lead a multidisciplinary team and ensure education for physicians and staff.