Director of Case Management

    September 10, 2022
    Houston, Texas
    Job Type


    We are seeking candidates for a Director of Case Management role for a 444 -bed acute care hospital  locate in Houston TX.

    Sign On up to $10K, Relo $10K

    General Comments

    Salary Range: $43.68 an HR – $54.60- $65.52. ( If they have at least 5 years of experience, they can offer between mid and max)

    Bonus Structure: 15% annually 4 performance bonus. If they perform extremely well there’s an upside so it could be higher (HR will go over the bonus structure with candidate)

    Shift Details: Days; 9 am -5pm

    Our client is a 444-bed acute care hospital in the heart of Houston’s museum district. Established in 1975, the hospital has been serving Houston for more than 40 years. It provides a wide range of medical services, including cardiology, bariatrics, orthopedics, neurology, emergency care and more.


    The division is a comprehensive network of hospitals, outpatient surgery centers, emergency centers and diagnostic imaging facilities in greater Houston, Corpus Christi and South Texas. Facilities include: 17 hospitals, nine ambulatory care centers, 13 off-campus emergency centers, and a regional transfer center.

    What you will do in this role:

    The individual in this position has overall responsibility for hospital utilization performance improvement and operational management of the Case Management Department in order to promote effective utilization of hospital resources, ensure processes support appropriate reimbursement for services rendered, support efficient patient throughput, and ensure compliance with all state and federal regulations related to case management services.


    This position integrates national standards for case management scope of services including:

    • Utilization Management supporting medical necessity and denial prevention
    • Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
    • Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care
    • Compliance with state and federal regulatory requirements, TJC accreditation standards and HCA policy
    • Education provided to physicians, patients, families and caregivers



    The individual’s responsibilities include the following activities:

    1. a) manage department operations to assure effective throughput and reimbursement for services provided,
    2. b) lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement,
    3. c) ensure medical necessity review processes are completed accurately and in compliance with CMS regulations and HCA policy,
    4. d) ensure timely and effective patient transition and planning to support efficient patient throughput,
    5. e) implement and monitor processes to prevent payer disputes, f) develop and provide physician education and feedback on hospital utilization, ,
    6. g) ensure compliance with state and federal regulations and TJC accreditation standards, and
    7. h) other duties as assigned.



    What qualification you will need:

    • Registered Nurse license
    • BSN Required
    • MSN preferred. Accredited Case Manager (ACM) preferred.
    • At least two years of RECENT (WITHIN THE LAST YEAR) acute hospital case management leadership experience.
    • Five years acute hospital case management experience preferred.

    Additional Notes:

    • Reason for Vacancy: Previous candidate got promoted
    • Direct report: to the CFO and Division
    • FTE: about 6. It's a small dept at Med Center
    • Type of culture (management style) of director or on the floor:  Culture is innovative, focused on patient care, leadership is supportive.




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