Director of Case Management

Veracity Ventures Inc.; Worcester (MA); On-site; USD 150,000 - 210,000; Full time

Job summary

Veracity Ventures Inc. seeks an experienced Director of Case Management to lead hospital-wide Case Management operations, Utilization Management, Care Coordination, and Transition Management.

This executive role focuses on optimizing patient throughput, length of stay, medical necessity, denial prevention, reimbursement, and safe transitions of care in a compliant environment. You will oversee the Case Management Department, drive performance using Utilization Management data, and partner with

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.

Responsibilities

• 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 patient throughput, discharge planning, and transitions of care.
• Support initiatives focused on reducing length of stay and 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.

Skills

Healthcare leadership

Case management

RN licensure

Education

Bachelor's degree in Nursing, Business, or Healthcare Administration

Master's degree in Social Work

Job description

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

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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