RN Case Management Lead - Utilization & Care Coordination

Baystate Noble Hospital; Springfield (MA); On-site; USD 119,000 - 162,000; Full time

Job summary

Baystate Health is seeking a Supervisor, Case Management to lead and oversee case management and utilization review activities. The role supports efficient patient care coordination, appropriate resource use, and timely transitions across the healthcare continuum.

Collaboration with clinical teams, physicians, and hospital leadership is essential to promote quality outcomes and regulatory compliance. The position emphasizes staff development, evidence-based practices, and guidance to case

Qualifications

• Minimum of three years of case management experience.
• Current Massachusetts Registered Nurse (RN) license.
• Associate degree required to practice as an RN in MA.

Responsibilities

• Oversee daily case management and utilization review workflows, assignments, and staffing to support departmental goals and performance expectations.
• Provide guidance to case managers on evidence-based practices, clinical guidelines, and appropriate case management interventions.
• Participate in case management and utilization review committees, communicate issues, and collaborate with the Physician Advisor.
• Assess admission appropriateness, level of care, and continued stay using screening criteria and guidelines.
• Monitor patient progression, length of stay, and discharge needs to support timely care transitions.
• Educate physicians and healthcare team members regarding length of stay and medical necessity.
• Ensure compliance with departmental policies, hospital requirements, and regulatory standards.

Skills

Case management experience

Leadership

Regulatory compliance

Education

Associate Degree in Nursing (ADN)

Massachusetts RN license

Bachelor of Science in Nursing (BSN)

Job description

Baystate Health is seeking a Supervisor, Case Management to lead and oversee case management and utilization review activities. The role supports efficient patient care coordination, appropriate resource use, and timely transitions across the healthcare continuum.

Collaboration with clinical teams, physicians, and hospital leadership is essential to promote quality outcomes and regulatory compliance. The position emphasizes staff development, evidence-based practices, and guidance to case