Director of Case Management

Pay: $133,000.00 per year

Job description:

Director of Case Management Gallup, NM

I am seeking an experienced healthcare leader to step into the role of Director of Case Management for a respected hospital in Gallup, New Mexico.

Position Summary

The Director of Case Management is responsible for the strategic and operational leadership of the Care Management department and Swing Bed Program. This role oversees staff and fiscal resources while working collaboratively across the healthcare continuum to deliver the highest quality of patient care in the most resource-appropriate manner.

Key Responsibilities

• Lead and mentor a dedicated team, fostering collaboration, motivation, and accountability.
• Oversee daily case management operations, ensuring compliance with CMS Conditions of Participation, accreditation standards, and insurance requirements.
• Direct the Swing Bed Program, including development, patient and community education, program promotion, and adherence to regulations.
• Act as an advocate for patients, utilizing strong knowledge of medical necessity criteria and payer coverage requirements.
• Partner with insurance carriers and community healthcare resources to optimize care and efficiency.
• Develop and maintain statistical reporting that demonstrates responsible allocation of hospital resources.
• Support quality improvement initiatives, regulatory readiness, and recovery audit preparedness.
• Perform case management duties as needed while modeling leadership and best practices.

Qualifications

• Associate of Science degree required; BSN strongly preferred.
• Current New Mexico RN or Social Work license required.
• Minimum five years of case management experience in an acute care hospital and/or managed care setting.
• Strong leadership skills with proven ability to build teams, inspire staff, and manage departmental budgets.
• Familiarity with federal and state accreditation standards, utilization management, and recovery audit preparedness.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Relocation assistance
• Vision insurance

Work Location: In person