Director of Case Management

Wheelersp; Worcester (MA); On-site; USD 118,000 - 183,000; Full time

Benefits offered by this job

Relocation assistance available

Job summary

Wheeler Staffing Partners seeks an experienced Director of Case Management for a pivotal leadership position in an acute care hospital in Worcester, MA. The role involves overseeing case management operations, ensuring compliance with standards, and enhancing patient outcomes.

The ideal candidate will have strong leadership skills, a relevant degree, and at least 3-5 years of case management leadership experience in an acute care setting.

Compensation ranges from $118,000 to $183,000 annually.

Qualifications

• Active RN or LCSW/LMSW license required.
• 3-5 years of acute care hospital case management leadership experience.
• Strong knowledge of CMS regulations and hospital standards.

Responsibilities

• Oversee daily operations of the hospital Case Management Department.
• Lead case management staff development and performance reviews.
• Monitor compliance with CMS regulations and accreditation standards.

Skills

Leadership skills

Utilization management

Care coordination

Discharge planning

Analytical skills

Communication skills

Education

Bachelor’s degree in Nursing or related field

Master of Social Work (MSW)

Master’s degree in Nursing or Healthcare Administration

Job description

Director of Case Management

Location: Worcester, MA

Employment Type: Full-Time | Direct Hire

Compensation: $118,000 - $183,000 annually

Relocation Assistance: Available based on distance

Position Overview

Wheeler Staffing Partners is seeking an experienced Director of Case Management for a leadership opportunity within an acute care hospital environment in Worcester, Massachusetts. This role is responsible for overseeing hospital utilization management, care coordination, transition planning, patient throughput, and operational leadership of the Case Management Department.

The Director of Case Management will lead utilization review and discharge planning initiatives to support appropriate reimbursement, improve patient outcomes, reduce avoidable days, and ensure compliance with all federal, state, and accreditation standards. This position works collaboratively with physicians, nursing leadership, revenue cycle teams, and interdisciplinary staff to drive operational efficiency and quality patient care.

Candidates must possess an active RN or LCSW/LMSW license and prior acute care hospital case management leadership experience.

Key Responsibilities

Case Management Leadership & Operations

• Oversee daily operations of the hospital Case Management Department
• Manage staffing levels, workflow distribution, and departmental productivity across seven-day operations
• Lead case management staff development, onboarding, competency evaluations, and performance reviews
• Conduct departmental meetings and ongoing education initiatives
• Support recruitment, coaching, corrective actions, and employee engagement activities
• Assist with department budgeting, operational planning, and performance improvement initiatives

Utilization Management

• Oversee hospital utilization review processes to ensure appropriate patient status, level of care, and medical necessity compliance
• Monitor compliance with CMS regulations, accreditation standards, and internal case management policies
• Lead denial prevention initiatives and support payer communication processes
• Monitor avoidable days, throughput metrics, and utilization trends to identify opportunities for operational improvement
• Participate in revenue cycle meetings and support denial management and reimbursement optimization efforts
• Support physician advisor review processes and peer-to-peer payer escalations

Transition Planning & Care Coordination

• Ensure transition planning assessments are completed within required timelines
• Support discharge planning and patient placement coordination activities
• Collaborate with nursing leadership, physicians, ancillary departments, and external providers to ensure efficient patient throughput
• Monitor care coordination documentation and transition planning compliance
• Participate in daily bed management and complex case review discussions
• Promote safe, timely, and patient-centered discharge planning processes

Regulatory Compliance & Quality

• Ensure compliance with federal, state, and accreditation standards impacting case management operations
• Maintain compliance with CMS Conditions of Participation and regulatory requirements
• Monitor departmental adherence to utilization review procedures and documentation standards
• Support implementation of audit recommendations and quality improvement initiatives
• Develop and maintain departmental policies, procedures, and operational protocols

Education & Training

• Provide education to physicians and interdisciplinary teams regarding medical necessity, utilization management, and regulatory compliance
• Lead ongoing staff education related to case management best practices and utilization review standards
• Support training initiatives related to InterQual criteria, documentation standards, and patient throughput processes
• Foster a culture of collaboration, accountability, and continuous improvement

Required Qualifications

Education

• Bachelor’s degree in Nursing, Healthcare Administration, Business, or related healthcare field required.
• Master of Social Work (MSW) required for Social Work candidates.
• Master’s degree in Nursing, Business Administration (MBA), or Healthcare Administration (MHA) preferred.

Licensure

• Active Registered Nurse (RN) license OR active LCSW/LMSW license required.

Experience

• 3-5 years of acute care hospital case management leadership experience required.
• 5+ years of acute hospital case management experience preferred.
• Experience with utilization management, denial prevention, discharge planning, and patient throughput initiatives required.
• InterQual experience preferred.
• Business planning and operational management experience preferred.

Preferred Certifications

• Accredited Case Manager (ACM) certification preferred.

Required Skills & Competencies

• Strong leadership and team management skills.
• Knowledge of utilization management, care coordination, discharge planning, and reimbursement processes.
• Strong understanding of CMS regulations, Joint Commission standards, and hospital accreditation requirements.
• Excellent communication, presentation, and relationship-building abilities.
• Analytical and problem-solving skills with the ability to interpret utilization and operational data.
• Experience managing multiple priorities in a fast-paced acute care hospital environment.
• Strong project management and performance improvement capabilities.
• Ability to collaborate effectively with physicians, nursing leadership, revenue cycle teams, payers, and interdisciplinary staff.
• Experience with EMR training and utilization analytics and reporting tools preferred.