Director of Case Management

Veracity Ventures Inc.•Worcester, MA

17h•$120,000 - $170,000•Onsite

About The Position

The Director of Case Management provides overall leadership and operational oversight for the hospital’s Case Management Department, including Utilization Management, Transition Management, Care Coordination, and patient throughput. This role is responsible for optimizing hospital resource utilization, supporting timely and accurate reimbursement, preventing denials, promoting safe and efficient patient transitions, and ensuring compliance with applicable state and federal regulations. The Director works collaboratively with physicians, clinical leaders, patients, families, and interdisciplinary teams to promote appropriate utilization of services, effective discharge planning, improved patient outcomes, and overall operational excellence.

Requirements

Bachelor’s degree in Nursing, Business, or Healthcare Administration for RN candidates; or Master’s degree in Social Work for MSW candidates.
Minimum 3 years of acute-care hospital case management or healthcare leadership experience.
Current and active RN, LCSW, or LMSW license, as applicable.
Must maintain all required professional licenses, certifications, and registrations in accordance with applicable state laws and organizational requirements.
Strong knowledge of utilization management, care coordination, discharge planning, medical necessity, and denial prevention.
Excellent leadership, communication, analytical, and relationship-building skills.

Nice To Haves

5+ years of acute-care hospital Case Management leadership experience, preferably in a multi-site environment.
Master’s degree in Nursing (MSN), Healthcare Administration (MHA), Business Administration (MBA), or Social Work (MSW).
Accredited Case Manager (ACM) certification.
Experience with hospital utilization management, revenue cycle processes, and CMS requirements.
Demonstrated success improving patient throughput, length of stay, utilization performance, and denial prevention.

Responsibilities

Provide strategic and operational leadership for the Case Management Department.
Oversee Utilization Management activities to support medical necessity, appropriate resource utilization, and denial prevention.
Lead implementation and oversight of the hospital’s Utilization Management Plan, using data and performance metrics to identify improvement opportunities.
Ensure medical necessity reviews and revenue cycle processes are completed accurately and in accordance with CMS regulations and organizational policies.
Oversee timely and effective transition and discharge planning to support appropriate length of stay and patient throughput.
Promote care coordination and ensure patients receive the right care at the right level and in the appropriate sequence.
Monitor case management performance, utilization trends, length of stay, denials, and other key operational metrics.
Develop and provide education and feedback to physicians and clinical teams regarding hospital utilization and appropriate levels of care.
Ensure compliance with applicable state and federal regulations, accreditation standards, and organizational policies.
Partner with interdisciplinary teams to improve patient outcomes, reduce avoidable readmissions, and enhance patient and caregiver satisfaction.
Provide leadership, coaching, and professional development to Case Management staff.
Perform other duties and responsibilities as assigned.