Job Description

Job Description: Director of Case Management

Location: Rutherfordton, NC

Salary: As per Exp.

Employment Type: Full Time

Client is a 143-bed acute care facility offering comprehensive inpatient and outpatient care. Committed to providing quality healthcare services, Rutherford Regional operates through the collaborative efforts of our dedicated medical staff and employees. We are proud to be part of Duke LifePoint Healthcare, a partnership that enhances our ability to serve the community with innovative, high-quality care.

We are seeking an experienced Director of Case Management to lead and manage the Case Management unit, ensuring effective clinical resource management, discharge planning, patient advocacy, and adherence to best practices in medical necessity determination and concurrent review. This role is vital for achieving optimized care coordination, meeting regulatory standards, and supporting the hospital's mission.

Leadership & Management

• Direct and oversee Case Management unit operations, including staffing, performance improvement, and departmental goal-setting aligned with the hospital's strategic plan.
• Foster a supportive, growth-oriented environment and develop professional growth opportunities for staff.
• Guide and coordinate care management activities in compliance with RRHS policies and regulatory requirements (e.g., CMS, Joint Commission).

Clinical Oversight & Patient Care Coordination

• Work closely with physicians, nurses, and other healthcare providers to facilitate multidisciplinary decision-making in patient care.
• Monitor and assess patient care quality and collaborate with staff to ensure optimal patient outcomes.
• Implement evidence-based practices and clinical protocols in care management operations.

Compliance & Reporting

• Educate staff on case management standards, regulatory requirements, and best practices.
• Ensure compliance with all relevant federal and state regulations, such as Conditions of Participation, OSHA, and HCFA.
• Maintain thorough knowledge of payer issues and strategies for revenue capture and cost reduction throughout the patient stay.

Operational Excellence

• Analyze patient data and trends to identify opportunities for service improvement and operational efficiencies.
• Collaborate with post-acute service providers to streamline patient transitions and improve community care post-discharge.
• Participate in strategic planning and performance improvement initiatives within RRHS and corporate teams.

Education & Licensing

• Associate's Degree in Nursing required; Bachelor's or Master's Degree in Nursing or a related field preferred.
• Current RN license to practice in NC (or multi-state compact license).

Certifications

• BLS required; ACMA Certification preferred.
• CCM Certification within the first year of employment or transfer to the role.

Skills & Experience

• Minimum 3 years of RN experience in acute care and/or care coordination.
• Minimum 3 years of management experience preferred.
• Critical thinking, decisive judgment, and the ability to work with minimal supervision.
• Strong understanding of care management, discharge planning, and government payer requirements.
• Proficiency with Interqual criteria, financial/budgetary processes, and government billing regulations.
• Exceptional communication, customer service, analytical, and problem-solving skills.
• Ability to manage multiple tasks effectively and work independently with high attention to detail.

• Choose from a range of Medical, Dental, and Vision plans to best fit your needs.
• HSA and 401(K) retirement plan contributions.
• Generous Paid Time Off.
• Accident & Critical Illness Insurance.
• Prescription Assistance through OptumRx.
• Family income protection programs, including life insurance, short/long-term disability, and identity theft protection.
• No-cost Employee Assistance Program for emotional, legal, financial, and daily life support available 24/7.
• Free travel and entertainment discount program.

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