Hiring: Corporate Director of Case Management and Utilization Review Company: Nexus Health Systems Location: Houston, TX Job Posted Time: 2026-09-03 10:17:27 Target Skills & Keywords : Regulatory Compliance About the job Experience: •Minimum seven years of progressive leadership experience in hospital case management, including direct oversight of both Case Management and Utilization Review. •Multi-site leadership experience required. •Demonstrated success implementing unified processes and performance standards across multiple facilities. •Strong expertise in medical necessity review, utilization management, care coordination, discharge planning, denial prevention, and length-of-stay management. •Demonstrated ability to translate clinical, operational, and financial data into measurable improvements. Required Skills: •The Corporate Director of Case Management & Utilization Review provides strategic direction and operational oversight for system-wide case management, utilization review, care coordination, discharge planning, and transitions of care. •Develop and execute a unified strategy connecting Case Management and UR across Nexus facilities. •Assess current operations, identify gaps and variation, and implement standardized policies, workflows, escalation procedures, and performance expectations. •Define responsibilities and handoffs between Case Management, UR, clinical teams, and revenue cycle to support coordinated care throughout the patient stay. •Anticipate changes in patient needs, payer practices, and operational demands, and recommend improvements to staffing, resources, and processes. •Partner with executive and facility leadership to align care management priorities with organizational goals. •Oversee admission and continued-stay reviews, authorization workflows, and timely communication with payers. •Promote consistent application of InterQual® criteria and applicable medical necessity requirements. Qualifications: •Bachelor of Science in Nursing (BSN) required. •Master of Science in Nursing (MSN) required. •Current, valid Texas Registered Nurse (RN) license required. Compensation: •Competitive benefits and rewards package Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!