| Title: | Case Management Director / Utilization Review / Discharge Planner / Swing Bed Coordinator |
| Description: | Discover Your Next Adventure in Pinedale, Wyoming!
Nestled in the heart of the breathtaking Wind River Range, Sublette County offers the rugged beauty of the West alongside a once-in-a-lifetime career opportunity. Sublette County Health proudly operates two clinics with urgent care services, both serving as Level 5 Trauma receiving Emergency Rooms, as well as two EMS stations. On August 4, 2025, we opened Sublette County’s first hospital – a historic milestone for our community and a new era in local healthcare.
As part of our growth, Heritage Home – our Skilled Nursing facility – is expanding to its new home with a 40-bed Skilled Nursing Unit and a brand-new 10-bed Memory Care Unit, designed to provide compassionate, resident-centered care.
As we continue to grow, we’re looking for dedicated, skilled, and compassionate professionals to join our team. Together, we’re building the future of healthcare in Sublette County – and we’d love for you to be part of it.
If you're ready for a rewarding career and a lifestyle filled with adventure, come be part of something extraordinary in Pinedale, Wyoming.
Learn more about our vibrant town at visitpinedale.org.
Summary Description
Primary focus of this role is organizational coordination, oversight,
and regulatory compliance across case management, utilization review, discharge planning and swing bed services, with direct involvement in patient care activities as operational needs require. Participates in departmental planning, workflow design, policy development, regulatory readiness activities, and quality improvement initiatives, and may recommend process and staffing changes to leadership.
Case Management: Plans and coordinates care of the patient from pre-hospitalization through discharge. Responsible for authorization of appropriate services for continued stay and through discharge.
Utilization Review/Discharge Planner:
Evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. The role ensures compliance with regulatory standards, payer requirements, while promoting optimal patient outcomes and cost-effective care.
Swing Bed Coordinator: Plans, organizes, evaluates and maintains swing bed functions of the critical access hospital. Works with all members of the healthcare team to ensure a collaborative approach is maintained in care and treatment of the patient. The role ensures patients transitioning from acute care to swing bed care receive appropriate services while maintaining regulatory compliance, optimizing reimbursement, and supporting quality outcomes.
Supervision Received
Reports to Chief Nursing Officer. Work is performed within established guidelines, procedures, and supervisory oversight. The position follows defined processes and refers unusual or complex matters to senior leadership.
Responsibilities: Case Management
1. Performs accurate assessments of each patient within 24 hours of admission to evaluate develop, and implement an individualized patient care plan that meets the medical, social, and emotional needs of each patient.
2. Reviews care and treatment for appropriateness against screening criteria and for infection prevention and control, quality, and risk assessment.
3. Works with all members of the healthcare team to ensure a collaborative approach is maintained in the care and treatment of the patient. Works with other departments to identify operational problems that affect care of the patient and develops solutions/resolutions.
4. Evaluates patient care on a regular basis and updates the care plan when needed.
5. Keeps patient informed of progress and provides information related to patient condition and diagnosis or disease progression. Meets with patient’s family to assist with disease management planning on discharge.
6. Coordinates with specialties when appropriate for optimal patient care.
7. Continues contact with patients with chronic diagnosis to assist with lifestyle changes as needed to prevent recurrence or exacerbation of chronic illness. Coordinates with the transitional care team for appropriate admission to that program.
8. Responsible for authorization of appropriate services for continued stay and through discharge.
9. Orders and arranges for homecare equipment and healthcare needs as necessary.
10. Reviews patient care activities for occurrences and trends that affect the quality, cost effectiveness and delivery of services. Ensures that the outcome of the review is appropriately maintained in the patient chart.
11. Assumes responsibility for timely completion of required case management reports for hospital leadership, regulatory bodies, health plans, insurance carriers, etc.
Utilization Review/Discharge Planner
12. Serves as liaison between the patient, family, facility, insurance, and outside resources and is responsible for performing assessments for Medicare, Medicaid, and high-risk patients to determine discharge planning needs.
13. Communicates with provider regarding discharge planning needs of the patient and facilitates post-hospital care.
14. Coordinates transitions to home, skilled nursing facilities (SNF), rehabilitation, long term care of hospice.
15. Monitor for avoidable days, delays in care, and denials, and assist with prevention strategies.
16. Collaborates with SCH Revenue Cycle Manager and employees that verify eligibility to assistance patients with knowledge and understanding of SCH billing and insurance companies’ payment practices.
17. Maintains current knowledge of resources available within the community, maintains supply of resource materials to distribute to patients when needed.
18. Communicates daily with admissions staff regarding admissions and discharges to various units.
19. Communicates with family members and caretakers regarding the needs of the patient and anticipated plans.
20. Documents discharge planning in an ongoing manner.
21. Is knowledgeable of patient’s financial status, diagnosis, and discharge needs.
22. Is responsible for home care needs being met by the time of discharge, with a goal of arrangements completed 24 hours prior to discharge when date of discharge is known.
23. Ensures compliance with CMS, CIHQ and payer-specific guidelines.
24. Serves as the SCH Utilization Review Committee chair and actively participates in Quality and Risk Management committees. Acts on performance improvement issues that are identified during committee meetings.
Swing Bed Coordinator
25. Coordinates admissions, transfers, and discharges for swing bed residents.
26. Performs resident assessment within 24 hours of admission, e.g., resident meeting, screening criteria.
27. Collaborates with physicians, nurses, and therapists to develop and implement the plan of care.
28. Follows the resident and the plan of care through the acute care phase to swing bed care to discharge from the swing bed to a new program of care or rehabilitation.
29. Monitors resident progress and length of stay.
30. Communicates with family members and caretakers regarding the needs of the resident and anticipated plans including community resources. Discharge planning goals are established in coordination with the resident and family/caretaker.
31. Educates resident and family on all aspects of the resident’s hospitalization and continuing care.
32. Communicates with physicians regarding discharge planning needs of the resident. Assists the physician to facilitate post-hospital care.
33. Maintains current knowledge of resources available within the community, maintains supply of resource materials to be distributed to residents when needed.
34. Accurately determines type of assistance/setting/resources necessary for the resident/family and provides appropriate resources/assistance/list of facilities.
35. Follows through on all resident referrals to agencies or other medical facilities and functions as a resident/family advocate.
36. Ensures compliance with CMS, Medicare and state swing bed regulations. Monitors eligibility criteria for Medicare Part A coverage.
37. Stays updated on regulatory changes affecting swing bed programs.
38. Prepare for an assist with regulatory inspections and surveys.
39. Educates staff on swing bed requirements and processes.
40. Implements quality improvement initiatives.
Other Duties as Assigned
Responsibilities may be adjusted or reassigned to ensure compliance, operational efficiency, internal controls, and workload balance. Performance expectations will align with assigned duties and available resources.
Qualifications
1. Current Wyoming Social Worker license with a bachelor or master’s degree in social work preferred, and/or
2. Current Wyoming Registered Nurse (RN) license with a BSN/MSN preferred.
3. Must maintain applicable licensure in good standing throughout employment as a condition of continued employment.
4. Three (3) or more years of previous experience in Case Management/Utilization
Review/Discharge Planning/Swing Bed care preferred.
Knowledge, Skills, and Abilities
1. Understanding of regulatory requirements, including federal, state, local regulations, and accrediting organization standards.
2. Knowledge of criteria for Medicare, Medicaid, HMO and private insurance coverage.
3. Communicates the mission, ethics, and goals of the hospital. Complies with all organizational policies regarding ethical business practices. Represents the organization in a positive and professional manner.
4. Demonstrates responsibility for knowing and adhering to SCH policies and procedures.
5. Understands the importance of patient confidentiality and HIPAA rules and regulations.
6. Demonstrates professional oral and written communication with the ability to exercise proper judgment and make independent decisions.
7. Ability to work in a team-oriented environment, communicate effectively, and demonstrates sensitivity to residents, visitors, and staff.
8. Strong multi-tasking skills with the ease of changing directions upon request and needs.
9. Ability to navigate and/or learn challenging system/processes.
10. A genuine regard and caring approach to helping people especially in extremely vulnerable and critical moments is a must.
11. Demonstrates the ability to be flexible, organized, and function under stressful situations.
Working Conditions
1. May require working on evenings, weekends, or holidays.
2. Subject to varying situations requiring the ability to interact effectively and respectfully with individuals of diverse backgrounds and protected characteristics, in accordance with federal and state equal employment laws.
3. Possible contact with a variety of people including prisoners and people with mental, emotional, and physical disabilities.
4. Medical office, exam room, laboratory, radiology, emergency room, and professional practice settings. Frequent exposure to communicable diseases and other conditions common to rural healthcare environments.
5. Work environment involves exposure to unusual elements, potentially dangerous materials, and situations that require following extensive safety precautions and may include the use of protective equipment.
6. May require travel between SCH site locations.
Physical Demands
1. Varied activities include moving, reaching, bending, and lifting.
2. Essential functions may be performed with or without reasonable accommodation in accordance with applicable law.
3. Requires manual and finger dexterity, and eye-hand coordination.
4. May require standing and moving for extended periods of time and occasional lifting or moving of items, generally up to fifty pounds, with or without assistance.
5. Requires corrected vision and hearing to normal range.
6. The position frequently requires working under stressful conditions and irregular hours.
Employment Relationship Disclaimer
1. This job description does not constitute a contract of employment, and employment remains at-will in accordance with Wyoming law.
2. The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. This document is not intended to be an exhaustive list of all responsibilities, skills, and working conditions for the people so classified. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.
HIPAA/Confidentiality:
1. Access to systems, resident records, and communications may include confidential and protected health information (PHI). The position is required to comply with all applicable HIPAA, Center for Medicare Services (CMS) and organizational confidentiality policies and completes mandatory training as required.
Job Type: Full-time
Pay: Dependent on Experience.
Benefits:
• Health, Dental and Vision Insurance
• HSA (Health Savings Account)
• Retirement program through Wyoming Retirement System
• Short- and Long-Term Disability
• Employee discount
• Life insurance
• Generous paid time off
How to Apply:
Interested parties should contact the Human Resources Department for Sublette County Health at recruiting@sublettehealthcare.com. Please include an application, resume and letter of interest. Applications can be found on the Sublette County Hospital District website.
We pride ourselves in developing and retaining our team members and our team prides itself in offering the best of care, close to home! Thank you for considering this opportunity to join our team. We look forward to receiving your resume.
About Pinedale:
Nestled at 7,175 feet in a scenic alpine valley, Pinedale is surrounded by three majestic mountain ranges—the Wind River, Wyoming, and Gros Ventre Mountains. As part of the Greater Yellowstone Ecosystem, the Bridger-Teton National Forest offers endless outdoor activities, with stunning landscapes and abundant wildlife.
Rich in history, Pinedale was shaped by the Rocky Mountain Fur Trade and is home to the nation's oldest cattle drive, the Green River Drift. Here, cowboys still guide cattle through town in June and October! The Green River Rendezvous was an annual event in the 1830s. Mountain Men, Trappers, Travelers and Indians all gathered in a valley "below the Green" river and bartered, traded, sold, and swapped various items such as skins, pelts, guns, jewelry and whatever else they needed. It continues to this day with people coming from all over to see the home-town parade, experience the pageant, see how the people who shaped the rugged west made there lasting impression and mark on our town.
Nature lovers will appreciate the nearby alpine lakes, perfect for fishing, water sports, and relaxation. Pinedale is also on the Path of the Pronghorn, where you can witness one of the last great animal migrations in the Western Hemisphere.
In town, you’ll find a warm community, local shops, restaurants, and attractions like the Museum of the Mountain Man and the Pinedale Aquatic Center. With its blend of outdoor adventure, rich history, and friendly locals, it’s easy to see why we call Pinedale home.
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| Company: | Sublette County Health |
| Salary: | |
| Post Date: | 5/22/2026 |
| Close Date: | Open Until Filled |
| Location: | Pinedale, Wyoming |
| Contact: | Human Resources Department |
| Phone: | |
| Email: | HR@sublettehealthcare.com |
| Website: | |
Mailing
Address: | |
|
 
Pinedale Online Job Board • www.pinedaleonline.com/jobboard
jobboard@PinedaleOnline.com
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