Senior Director, Utilization & Case Management

The Senior Director of Utilization and Case Management drives execution, alignment, and performance of care management programs in the acute care system, ensuring consistent standards, scalable processes, and sustainable outcomes at the individual hospital level. This role provides critical system leadership to critical to advancing a high-performing, integrated care management model across our acute care system.

The ideal candidate will have a clinical background (RN or social work preferred), deep experience in utilization review and inpatient case management, proven results in LOS, denials and throughput, and strength in leading teams in a matrixed health system.

• Provide system-wide leadership, oversight, and accountability for utilization review, case management, and inpatient social work
• Lead employee and provider engagement efforts, including interdisciplinary rounding (IDTs), coaching, and action planning
• Ensure operational effectiveness and consistency across facilities, including staffing models aligned with best practices and appropriate skill mix
• Develop and execute mid- to long-term strategic plans, driving measurable improvements in:
  • Length of stay (LOS) and avoidable days
  • Denial rates, appeals, and payer performance
  • Care transitions, readmissions, and patient experience
• Ensure consistent application of evidence-based criteria
• Partner with the SVP, Chief Physician Executive, and Chief Physician Advisor to advance utilization management, physician engagement, and clinical documentation improvement (CDI)
• Lead cross-functional initiatives that align operational, clinical, quality, and financial goals across the system
• Oversee appeals and grievance processes, ensuring alignment with payer requirements and system strategy
• Drive standardization and continuous improvement in workflows, resource utilization, and care management practices
• Ensure regulatory compliance and adherence to system policies and standards

• Master's degree or bachelor's plus 2 additional years of experience
• 8 years of experience