Director of Case Management (FT)
Location: Worcester, Massachusetts
Setting: Acute Care Hospital Environment
Employment Type: Full-Time
Estimated Pay Rate: $119,000 $183,000 per year
Job Overview
We are seeking an experienced Director of Case Management to lead hospital-wide utilization management, transition management, and care coordination operations within an acute care setting in Worcester, Massachusetts.
This leadership role is responsible for ensuring efficient patient throughput, regulatory compliance, revenue cycle integrity, and high-quality discharge planning processes. The Director will oversee the Case Management Department and drive performance improvement initiatives aligned with national case management standards.
The position integrates utilization management, length-of-stay optimization, denial prevention, and safe patient transitions while supporting physicians, nursing teams, patients, and families.
Key Responsibilities
Lead and manage overall Case Management Department operations
Oversee utilization management processes to ensure medical necessity compliance and efficient resource use
Drive initiatives to improve patient throughput and reduce unnecessary length of stay
Ensure accurate and timely discharge planning and transition of care coordination
Monitor and reduce avoidable denials through proactive clinical and administrative strategies
Collaborate with physicians and clinical teams to support appropriate level-of-care decisions
Ensure compliance with all applicable regulatory requirements and accreditation standards
Provide education, coaching, and feedback to physicians and staff on utilization practices
Support revenue cycle performance through accurate documentation and process optimization
Lead quality improvement and performance initiatives within case management services
Requirements
Active Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW/LMSW) license required
Bachelor's degree in Nursing, Social Work, Health Administration, or related field required
Minimum 3 years of acute care case management experience required
Leadership or supervisory experience in a hospital setting required
Strong understanding of utilization management, care coordination, and discharge planning processes
Knowledge of regulatory standards including CMS and hospital accreditation requirements
Strong communication, leadership, and decision-making skills
Ability to manage multidisciplinary teams in a fast-paced hospital environment
Preferred Qualifications
Advanced degree (MSN, MBA, MHA, or MSW) preferred
Experience in multi-site or large hospital systems preferred
Case Management certification (ACM) preferred