The Director of Case Management and Social Work (CMSW) provides strategic and operational leadership to ensure high-quality, patient-centered care that responsibly serves both the community and the organization. This role is instrumental in advancing equitable access to care, supporting vulnerable populations, and strengthening partnerships across the care continuum to reduce preventable readmissions and improve health outcomes.

As a senior leader, the Director oversees all daily operations of the Case Management and Social Work departments, fostering a collaborative, high-performing team culture built on accountability, professional development, and compassionate service. The Director recruits, mentors, and manages department staff while promoting interdisciplinary collaboration with medical, nursing, HIM, and senior leadership teams.

With a strong focus on fiscal responsibility, the Director drives effective resource utilization to reduce length of stay and cost per case without compromising quality of care. Through data-driven decision-making and utilization management, the role ensures responsible stewardship of organizational and community resources.

The Director serves as the critical link between clinical documentation, compliance, and reimbursement, working closely with the HIM department and providers to ensure accurate physician documentation that reflects severity of illness and complexity of care. Deep knowledge of CMS regulations and Conditions of Participation is essential to maintaining compliance and supporting sustainable operations.

Through leadership in care coordination, utilization reporting, and community outreach, the Director of Case Management and Social Work plays a vital role in promoting continuity of care, regulatory excellence, and long-term community health.

Responsibilities:

Provides supervision and guidance to Case Management (CM) staff- scheduling, performance management, training, and accurate and concise documentation. Leadership of Complex Case Meetings and Monitors Interdisciplinary Rounds (IDRs) -Plays an active role co-chairing IDR workgroup. Collaborates with nursing to ensure workgroup is meeting at minimum monthly to report and review audit scores, identify opportunities for improvement, and develop and implement action plans to improve IDR processes and outcomes.  Performs Audits of Case Management Staff Assessments, Reviews and Documentation -Assists with regulatory compliance and risk management Maintain an Active Role in Denials and Appeals- Verifies staff comprehension and utilization of HINNs, MOON, IMM and other required payer/government notices and escalates concerns to Physician Advisor, COO/CNO, and/or CFO as appropriate

Requirements:

Active New York State RN Licensure and BS or BSN Degree required. Masters' Degree in a related field is preferred. Candidates must have a minimum of five (5) years' leadership experience in Case Management, Utilization Management and Quality Assessment, or a minimum of five (5) years' leadership experience in a related field. Eligible for or certified in Case Management is desirable. Extensive knowledge of all CMS regulations and conditions of participation is essential.

Ellis Medicine is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, and will prohibit, discrimination on the basis of race, creed, color, religion, sex/gender (including pregnancy), age, national origin, disability (including pregnancy-related conditions), genetic information, predisposition or carrier status, military or veteran status, prior arrest or conviction record, marital or familial status, sexual orientation, transgender status, gender identity, gender expression, reproductive health decisions, domestic violence victim status, known relationship or association with any member of a protected class, and any other characteristic protected by applicable law violates federal, state and, where applicable, local laws , reproductive health decisions or source of payment, consistent with applicable legislation and to comply with the laws pertaining thereto.

Salary Range:  $41.30-$61.94     /hour  Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.