Director of Case Management

Location: Worcester, MA
Employment Type: Full Time
Work Setting: Onsite

Lead Hospital Case Management & Patient Flow

We are seeking an experienced Director of Case Management to lead hospital-wide Case Management operations, Utilization Management, Care Coordination, and Transition Management.

This leadership role is responsible for optimizing patient throughput, length of stay, medical necessity, denial prevention, reimbursement, and safe transitions of care while ensuring compliance with applicable regulatory and accreditation standards.

What You'll Do

Lead the daily operations and performance of the Case Management Department
Oversee the hospital Utilization Management Plan and use data to drive performance improvement
Ensure accurate medical necessity reviews and utilization processes in accordance with CMS requirements and organizational policies
Drive effective patient throughput, discharge planning, and transitions of care
Support appropriate length of stay and initiatives focused on readmission prevention
Partner with physicians and clinical teams to improve utilization and patient flow
Provide education and feedback to physicians regarding hospital utilization and medical necessity
Promote compliance with state and federal regulations and accreditation standards
Support denial prevention and revenue-cycle processes related to case management
Lead initiatives that improve patient experience, care coordination, and operational efficiency

What We're Looking For

Required Qualifications

Bachelor's degree in Nursing, Business, or Healthcare Administration for RN candidates, or Master's degree in Social Work for MSW candidates
At least 3 years of acute hospital Case Management or healthcare leadership experience
Active RN, LCSW, or LMSW license as applicable
Current licensure/registration required to practice in the state of Massachusetts

Preferred Qualifications

5+ years of acute hospital Case Management leadership experience
Multi-site Case Management leadership experience
Master's degree such as MSN, MBA, MHA, or MSW
Accredited Case Manager (ACM) certification

Why This Opportunity?

This is an opportunity for a seasoned healthcare leader to make a hospital-wide impact across utilization management, patient flow, care coordination, reimbursement, and quality outcomes.

If you have strong acute-care Case Management leadership experience and are ready to lead strategic initiatives that improve both patient care and hospital operations, we'd like to hear from you.

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Compensation: $119,000.00 - $173,000.00 per year

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Do you have at least 3 years of acute hospital Case Management or healthcare leadership experience? -*

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