Director of Case Management / Utilization Review / Business Development

About the role

Hamilton Memorial Hospital District is seeking an experienced and motivated Director of Case Management / Utilization Review / Business Development to join our leadership team. This position plays a vital role in ensuring high-quality, patient-centered care by providing leadership in case management, utilization review, discharge planning, resource management, and strategic business development.

Qualifications

• Current Illinois Registered Nurse (RN) license required.
• Bachelor of Science in Nursing (BSN) preferred.
• Experience in case management and discharge planning required.
• Working knowledge of insurance processes and government reimbursement programs.
• Critical Access Hospital experience preferred.
• Valid driver license, reliable transportation, and current auto liability insurance required.

Responsibilities

• Lead the hospital case management, utilization review, discharge planning, and resource management programs.
• Ensure compliance with CMS Conditions of Participation (CoPs), accreditation standards, and applicable regulatory requirements.
• Develop and implement safe, patient-centered discharge plans and coordinate transitions of care.
• Identify barriers to discharge and opportunities to reduce length of stay and prevent avoidable readmissions.
• Oversee utilization review processes for inpatient, emergency department, and swing bed patients.
• Collaborate with physicians, interdisciplinary teams, payors, and post-acute providers to ensure appropriate utilization and reimbursement.
• Facilitate multidisciplinary care coordination meetings.
• Build and strengthen referral relationships with physicians, healthcare organizations, and community partners.
• Educate providers, case managers, and community members about hospital services and specialty programs.
• Participate in community outreach activities and business development initiatives.
• Support quality improvement efforts and organizational strategic goals.

Requirements

• Strong leadership, organizational, and problem-solving skills.
• Excellent communication and relationship-building abilities.
• Knowledge of utilization review, case management, reimbursement, and regulatory requirements.
• A commitment to quality improvement, patient safety, and exceptional patient care.
• The ability to manage multiple priorities in a fast-paced healthcare environment.

Benefits

Competitive pay based on experience and education
Set, flexible schedule
Free CEUs for licensing
Excellent benefits package. View here: https://hmhospital.org/career_benefits/

Position Highlights

• Full-time leadership position
• Primarily scheduled Monday through Friday; however, occasional after-hours communication may be necessary to facilitate patient placement, utilization review, discharge planning, or swing bed referral opportunities.
• Reports to the Chief Nursing Officer/Chief Clinical Officer
• Opportunity to make a meaningful impact on patient care, operational excellence, and community outreach

Essential Responsibilities

• Lead the hospital case management, utilization review, discharge planning, and resource management programs.
• Ensure compliance with CMS Conditions of Participation (CoPs), accreditation standards, and applicable regulatory requirements.
• Develop and implement safe, patient-centered discharge plans and coordinate transitions of care.
• Identify barriers to discharge and opportunities to reduce length of stay and prevent avoidable readmissions.
• Oversee utilization review processes for inpatient, emergency department, and swing bed patients.
• Collaborate with physicians, interdisciplinary teams, payors, and post-acute providers to ensure appropriate utilization and reimbursement.
• Facilitate multidisciplinary care coordination meetings.
• Build and strengthen referral relationships with physicians, healthcare organizations, and community partners.
• Educate providers, case managers, and community members about hospital services and specialty programs.
• Participate in community outreach activities and business development initiatives.
• Support quality improvement efforts and organizational strategic goals.

Ideal Candidate

We are looking for a collaborative healthcare leader who demonstrates:

• Strong leadership, organizational, and problem-solving skills
• Excellent communication and relationship-building abilities
• Knowledge of utilization review, case management, reimbursement, and regulatory requirements
• A commitment to quality improvement, patient safety, and exceptional patient care
• The ability to manage multiple priorities in a fast-paced healthcare environment

Application

If you are passionate about improving patient outcomes while helping shape the future of healthcare in our community, we would love to hear from you.
Apply today and become part of the Hamilton Memorial Hospital District team dedicated to providing compassionate, high-quality care close to home.
If interested, contact: [email protected]
Mail your application to:
Hamilton Memorial Hospital
c/o Human Resources
PO Box 429
McLeansboro, IL 62859
Or Fax your application to: 618-643-2875
Or email your application to: Bobbie Hamblin.

Pay & Schedule

Wage Range: $35.00 - $50.40