Job Title: Director of Managed Care Credentialing Department: Managed Care Reports To: Chief Population Health Officer Location: Regional (Multi-Facility Oversight) Travel: Up to 75% To: Chief Population Health Officer Location: Regional (Multi-Facility Oversight) Travel: Up to 75%

Job Summary: The Regional Director of Case Management is responsible for the strategic oversight and operational leadership of case management functions across multiple skilled nursing facilities (SNFs) across the State. This individual ensures effective coordination of care, optimal utilization of services, compliance with regulatory requirements, and successful transitions of care to support both quality outcomes and financial goals.

Key Responsibilities

• Provide leadership and guidance to facility-level case management teams across the State.
• Develop, implement, and standardize case management policies, procedures, and best practices.
• Monitor the adherence to core case management processes and systems.
• Ensure compliance with federal, state, and local regulations, as well as payer specific guidelines (e.g., Medicare, Medicaid, Managed Care).
• Collaborate with interdisciplinary teams to optimize length of stay, reduce hospital readmissions, and improve patient outcomes.
• Review and analyze data related to utilization review, case mix, and reimbursement trends; develop action plans to address gaps.
• Conduct regular audits of case management documentation and practices.
• Serve as a liaison with hospitals, payers, and community resources to strengthen care coordination pathways.
• Provide training and mentorship for case managers across facilities.
• Participate in strategic planning for census development, payer mix optimization, and quality initiatives.
  
  

Qualifications: Education:

• Licensed Vocational Nurse or Registered Nurse
  
  

Experience

• Minimum 5 years of case management experience, with at least 2 years in a skilled nursing or post-acute setting.
• Experience with billing within the skilled nursing space.
• Prior multi-facility or regional leadership experience strongly preferred.
  
  

Skills

• In-depth knowledge of Medicare/Medicaid regulations, managed care, and discharge planning.
• Strong analytical, organizational, and leadership skills.
• Excellent communication and relationship-building abilities.
• Proficient in EMR systems and case management software.
  
  

Physical Requirements

• Ability to travel regularly throughout the State
• Must be able to work in a fast-paced, multi-facility environment.
• Ability to sit, stand, and walk for extended periods as needed.