Corporate Director of Care Management
About the role
The Corporate Director of Care Management oversees operational and clinical leadership for care management functions across multiple Nexus facilities, partnering with executive leadership, physicians, nursing teams, and interdisciplinary departments to drive exceptional patient outcomes, regulatory compliance, patient throughput, and financial performance.
Responsibilities
Lead and standardize care management operations across assigned facilities
Oversee utilization review, discharge planning, care coordination, and transition of care processes
Ensure compliance with CMS Conditions of Participation, Joint Commission/DNV standards, and URAC principles
Establish and oversee Utilization Management Committee operations
Collaborate with physician advisors regarding medical necessity determinations and documentation quality
Implement InterQual® criteria for admission status, continued stay reviews, and discharge readiness
Promote Neurodevelopmental Disabilities (NDD)-informed care practices throughout care management workflows
Support interdisciplinary collaboration to improve patient throughput and continuity of care
Monitor regulatory compliance related to utilization review and discharge planning
Lead performance improvement initiatives and accreditation readiness efforts
Conduct audits related to documentation, appeals, timeliness, and care coordination practices
Promote patient safety and continuous quality improvement across facilities
Ensure accurate documentation supporting medical necessity and fiscal reimbursement
Support person-centered discharge planning and patient advocacy initiatives
Afford sensory-friendly environments and communication accommodations for neurodiverse patients
Assist patients and families with community resources, financial assistance, and care transitions
Collaborate with patients, caregivers, and healthcare teams to prevent fragmentation of services
Provide mentorship, coaching, and operational guidance to care management teams
Oversee recruitment, onboarding, and professional development for department staff
Develop competency pathways and leadership development programs
Encourage professional certification attainment including CCM, ACM-RN, ACM-SW, and CPHQ
Facilitate annual education and training related to InterQual®, CMS regulations, and best practices
Optimize length of stay and reduce avoidable days through proactive utilization management
Monitor throughput, payer denials, appeals, case mix, and departmental performance metrics
Develop and manage departmental budgets and resource allocation
Collaborate with payers and physician advisors to support efficient, cost-effective care delivery
Ensure equitable care management services regardless of payer source
Qualifications
Minimum 7 years of progressive leadership experience in hospital case management
Multi-site leadership experience required
Strong background in utilization review, discharge planning, and care coordination
Experience working with neurodevelopmental, behavioral health, and medically complex populations strongly preferred
Knowledge of CMS regulations, Joint Commission/DNV standards, and utilization management practices
Licensure & Certifications:
Current and valid Texas Registered Nurse (RN) license required
Case Management Certification required (ACM, CCM, CMGT, FAACM, or equivalent)