Director of Care Management

Employment Type: Full-time

Shift: Day Shift, Monday- FridayLocation: St. Mary Medical Center- Langhorne, PA

Nazareth Hospital- Philadelphia, PA

Position Purpose:

The Director of Care Management will direct the department in a collaborative model focused on patient-centered care and the deliberate organization of services across the continuum. This role bridges the acute setting and community transition by establishing formal partnerships and ensuring seamless information sharing among multidisciplinary teams to eliminatebarriers to discharge. The goal is to facilitate communication and resource coordination through advocacy, education, and comprehensive assessment of social determinants, while managing transitions and disease management programs. Responsibilities include the oversight of compliance standards and clinical outcomes—specifically targeting reduced fragmentation in care and optimized length of stay to improve readmission rates, capacity management, and financial indicators.

What You Will Do:

• Directs the overall care management program, including case management, social work, and utilization review.

• This involves setting departmental goals, establishing policies, and managing budgets.

• Maintains collaborative relationship with Medical Staff and facilitates education on documentation, government regulations and payer contracting matters

• Oversees processes to ensure patients are at the correct level of care (e.g., observation vs. inpatient) and that hospital resources are used efficiently.

• Lead the Utilization Management Committee to report on denial trends and resource consumption

• Assures hospital adherence to all Federal, State, and Local regulatory and compliance guidelines related to utilization

• Oversight of critical processes related to compliance of both medical necessity and appropriate level of care; coordinates utilization review processes to assure adherence to regulations

• Supports the Utilization Management and Appeals Supervisor and the Manager of Care Management to assure the functions of care coordination in the acute setting meet the goals of resource consumption, capacity management and patient centered care

• Develops programs to support length of stay initiatives to manage capacity and assure the right care at the right time

• Assures hospital adherence to all regulatory guidelines related to discharge planning

• Continuously seeks best practice approaches to assuring patients are discharge ready including coordination of services, coaching, and transition of information

Minimum Qualifications:

• Master of Science in Nursing (MSN) degree from an accredited school of nursing required.

• Current Registered Nurse license by Pennsylvania Board of Nursing or Compact State.  

• At least 3-5 years' leadership experience in case management

• CCM (Certified Case Manger) or ACM (Accredited Case Manager) preferred

Position Highlights and Benefits:

• Comprehensive benefit packages, including medical, dental, vision, mental health, paid time off, 403B, education assistance and voluntary benefits (pet insurance, accident insurance, hospital indemnity and others) available from the first day of employment.  

• Work/Life balance with flexible schedules.  

• Free onsite parking.  

• Our mission and core values are what drive each member of Trinity Health to support each other, communicate openly and respectfully while embracing a culture that nurtures a healing, safe environment for all.   

• Referral Rewards Program 

About us:

St. Mary Medical Center is a beautiful 53-acre state-of-the-art facility comprised of more than 700 physicians, nearly 3,000 colleagues, and 1,100 volunteers committed to providing quality care delivered with compassion and respect.  St. Mary attracts top doctors, introduces cutting-edge technologies and implements advanced procedures to meet the healthcare needs of the people it serves, including the nearly 630,000 residents of Bucks County.  

Nazareth Hospital serves Northeast Philadelphia and the surrounding region. With over 160 inpatient beds and many outpatient services, Nazareth Hospital has a broad range of specialties to meet patients’ health care needs.  Nazareth Hospital offers outstanding diagnostic, medical, surgical and therapeutic care with state-of-the-art technology. With the dedication of 1,200 employees and 350+ physicians and specialists, Nazareth Hospital treats patients and their families with respect and compassion while providing health care services in response to the changing needs of our community.