Job Description

Director Inpatient Care Management

Salary Range

138,419.54 - 214,550.29 USD Annual

Summary

The Director Inpatient Care Management provides strategic and operational leadership for care management, utilization management, discharge planning, transitions of care for the acute care setting, and population health initiatives across a three-hospital health system. This leader is responsible for ensuring regulatory compliance, optimizing resource utilization, improving patient outcomes, reducing avoidable readmissions, and supporting financial performance through effective utilization review and care coordination practices.

The Director collaborates closely with executive leadership, physicians, nursing leaders, case managers, social workers, revenue cycle teams, and community partners to ensure patients receive the right care, in the right setting, at the right time.

Education

Bachelor’s degree in nursing AND a master's degree in a health-related/science field.

Certification, Registration, and Licensure

New Hampshire Registered (RN) License

Certified Case Manager (CCM), Accredited Case Manager (ACM), or related certification strongly preferred.

Experience

• Minimum of 7–10 years of progressive leadership experience in Care Management, Case Management, Utilization Review, or Population Health.
• Minimum of 5 years of management experience within a hospital or integrated health system.
• Experience overseeing multi-site or multi-hospital operations preferred.
• Demonstrated success and process improvement in utilization management, denial prevention, throughput improvement, and care transition initiatives

Responsibilities

• Develop and implement a system-wide vision, strategy, and operational plan for Care Management and Utilization Review.
• Standardize care management and utilization review processes across all hospitals and care settings.
• Lead initiatives that improve quality outcomes, patient experience, throughput, length of stay, and cost-effective care delivery.
• Support organizational goals related to value-based care, population health, and regulatory compliance.
• Direct inpatient and outpatient care management services, including case management, social work, discharge planning, and care coordination.
• Ensure timely and effective patient assessments, care planning, and transition-of-care activities.
• Promote interdisciplinary collaboration to address clinical, psychosocial, and financial barriers to care.
• Develop programs that reduce readmissions and improve post-acute care transitions.
• Oversee utilization review processes to ensure appropriate level of care determinations and compliance with payer requirements.
• Monitor medical necessity reviews and authorization processes.
• Collaborate with physicians and clinical documentation teams to support accurate patient status determinations.
• Lead denial prevention and appeals strategies to minimize revenue loss and improve reimbursement.
• Analyze utilization and length-of-stay data to identify opportunities for improvement.
• Ensure compliance with CMS Conditions of Participation, Joint Commission standards, state regulations, and payer requirements.
• Maintain readiness for regulatory surveys, audits, and accreditation reviews.
• Leadership and staff development.

Physical and Work Requirements

The physical demands and characteristics of the work environment described here are representative of those that will be encountered by an employee to successfully perform the essential functions of this job.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The Dictionary of Occupational Titles Material Handling Classification is MEDIUM. The employee must regularly lift, carry or push/pull up to 10 pounds, frequently lift, carry or push/pull up to 10 - 25 pounds, and occasionally lift, carry or push/pull up to 20 - 50 pounds.

While performing the duties of this Job, the employee is regularly required to do fine motor, hear, speak, and walk. The employee is frequently required to bend, reach, sit, squat, and stand. The employee is occasionally required to climb, do repetitive motion, kneel, and smell.

Specific vision abilities required by this job include color vision, depth perception, far vision, near vision, and peripheral vision.

The employee is frequently exposed to airborne pathogens, blood borne pathogens, and bodily fluids. The employee is occasionally exposed to airborne contaminants, chemotherapeutic agents, electrical hazards - shock, moving mechanical parts, non-weather related heat or cold, slippery surfaces, and toxic or caustic chemicals.

The noise level in the work environment is usually moderate.