Executive Director, Case Management

Beth Israel Lahey Health

8d•$185,000 - $220,000

About The Position

The Executive Director of Case Management provides strategic and operational leadership for the enterprise Case Management program across all Beth Israel Lahey Health (BILH) facilities. The role leads the transformation from decentralized site-based operations to an integrated, centralized enterprise function with standardized processes, shared best practices, and consistent performance. The position develops and executes care coordination strategies to optimize patient throughput, support safe and timely transitions of care, reduce avoidable readmissions, and advance population health and value-based care objectives. It partners with senior clinical and operational leaders, payer partners, service line leaders, and post-acute care partners to align initiatives with organizational goals for care coordination and length-of-stay optimization. The Executive Director oversees enterprise Case Management strategy, standardization, care coordination, regulatory compliance, quality, financial and operational performance, analytics, and talent development. This includes building governance and change-management structures for enterprise integration; developing partnerships and standardized workflows; ensuring compliance with discharge-planning requirements; and using performance metrics to guide improvement. The role also leads and develops Case Management leadership and staff, engages physicians and clinical leaders, and reports program value and performance to executive and board-level audiences.

Requirements

Bachelor's degree in Nursing, Healthcare Administration, Health Information Management, or a related healthcare field.
Minimum 8 years of progressive leadership experience in Case Management and/or Utilization Management.
Minimum 3 years in senior leadership roles with multi-site responsibility.
Demonstrated experience managing teams and achieving measurable operational and financial outcomes.
Experience with Case Management post-acute partnerships.
Experience leading regulatory compliance initiatives and responding to external audits.
Executive presence and ability to influence and partner with senior clinical and operational leadership.
Deep expertise in care coordination, discharge planning requirements, and transitions-of-care standards.
Comprehensive knowledge of CMS Conditions of Participation for Discharge Planning and related regulatory requirements.
Strong understanding of the post-acute care landscape, including SNF, LTACH, IRF, home health, and hospice level-of-care criteria.
Strategic thinking and ability to translate organizational priorities into actionable care coordination initiatives.
Advanced analytical skills, including interpreting length-of-stay data, readmission patterns, and throughput metrics.
Experience with Epic EHR and Case Management workflow technologies.
Exceptional communication skills and ability to present to executive and board-level audiences.
Change-management expertise and demonstrated success leading process improvement initiatives.
Understanding of value-based care models and their impact on utilization management strategies.
Budget development and vendor management experience.
Demonstrated success leading organizational transformation and centralization initiatives.
Ability to build consensus and influence stakeholders across multiple sites with diverse operational cultures.
Experience navigating complex political dynamics when transitioning from site autonomy to enterprise standardization.
Strong diplomatic skills and ability to balance enterprise efficiency goals with facility-specific needs and concerns.
All staff are required to be vaccinated against influenza as a condition of employment.

Nice To Haves

Master's degree in Nursing, Healthcare Administration, Public Health, or a related field.
Active RN license.
Active LCSW/LICSW.
ACM (Accredited Case Manager), CCM (Certified Case Manager), or CMGT-BC (Nurse Case Manager Board Certified) certification.
Experience in an academic medical center or large integrated delivery network.
Clinical background in acute care nursing, case management, social work, or utilization review.
Experience with AI or predictive analytics applications in care coordination and readmission prevention.
Published research or presentations at national conferences (NAUM, ACMA, CMSA).
Teaching or training experience in a healthcare-related discipline.
Experience serving on organizational committees such as Quality, Patient Safety, or Revenue Cycle.

Responsibilities

Develop and execute enterprise-wide Case Management strategic plans aligned with clinical, financial, quality, and population health objectives.
Evaluate, select, and manage Case Management technology solutions and vendor partnerships.
Design and operationalize standardized Case Management policies, procedures, and best practices across BILH facilities, including the transition to an integrated enterprise model.
Serve as executive sponsor for the Case Management Committee and lead annual review and implementation of the system-wide Case Management Plan.
Drive innovation in care coordination models and establish partnerships with post-acute providers, community resources, and payer care management teams.
Assess current Case Management practices across hospitals and identify opportunities for standardization, efficiency, and best-practice adoption.
Develop change-management strategies, governance structures, communication plans, and phased implementation plans to support enterprise integration while accounting for facility-specific clinical needs.
Build consensus among site leadership and establish standardized work queues, case assignment methods, productivity expectations, and feedback mechanisms.
Oversee enterprise care coordination and safe, timely transitions across the continuum of care.
Optimize patient throughput and reduce length of stay through proactive discharge planning, barrier identification, and escalation processes.
Develop complex case management programs for high-risk, high-utilizer, and medically complex populations.
Integrate psychosocial assessments, social determinants of health screening, and community resource navigation into care coordination workflows.
Collaborate with post-acute care partners to support appropriate care placement, reduce readmissions, and improve outcomes.
Partner with Population Health, Value-Based Care, and ACO teams to align strategies with risk-based contract requirements and quality metrics.
Collaborate with Social Work leadership to coordinate support for patients with complex psychosocial needs.
Ensure enterprise-wide compliance with CMS Conditions of Participation for Discharge Planning and applicable patient choice, IMM, federal, and state requirements.
Lead organizational responses to regulatory changes, accreditation surveys, and external reviews related to care coordination and discharge planning.
Collaborate with Compliance, Legal, Quality, and Patient Experience departments on care coordination risks and findings.
Monitor and report quality metrics, including readmissions, patient satisfaction with discharge processes, and care transition effectiveness; implement strategies to reduce avoidable readmissions.
Oversee Case Management operations with accountability for length-of-stay optimization, appropriate level-of-care placement, and denial reduction.
Collaborate with Utilization Management leadership and Physician Advisors on length-of-stay and level-of-care optimization.
Measure financial and operational impact, and develop executive reporting and dashboards demonstrating program value and ROI.
Lead business case development for technology investments and staffing optimization; conduct benchmarking against peer academic medical centers and national standards; and manage the departmental budget.
Lead and develop Case Management leaders and an enterprise workforce of employed staff and contract labor through recruitment, onboarding, competency assessment, professional development, training, career pathways, and succession planning.
Lead organizational change-management initiatives related to Case Management process improvements and technology implementations, and foster collaboration with utilization management, social work, and clinical teams.
Build collaborative relationships with Chief Nursing Officers, Chief Medical Officers, Physician Advisors, and department chairs.
Partner with clinical leadership to address inappropriate admissions, delayed discharges, and care-setting optimization opportunities.
Educate clinical staff and physicians on care coordination practices, regulatory requirements, and documentation standards.
Serve as the organizational expert on utilization management best practices, regulations, and payer policies; lead Physician Advisor integration into complex cases and appeals.
Optimize observation services utilization and inpatient admission appropriateness.
Establish enterprise Case Management dashboards and key performance indicators; use analytics to identify utilization patterns, variation, discharge barriers, throughput bottlenecks, and intervention opportunities.
Lead data-driven performance improvement initiatives and translate utilization data into presentations for diverse stakeholders, including the Board.
Monitor denial trends in discharge disposition, post-acute utilization, and readmissions, and implement corrective action plans.