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Job description
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
Why Work With Wheeler Staffing Partners?
Wheeler Staffing Partners connects healthcare professionals with leading organizations nationwide. Our team specializes in placing top talent within healthcare leadership, clinical operations, case management, revenue cycle, nursing leadership, and hospital administration roles. We are committed to helping professionals advance their careers while supporting organizations dedicated to exceptional patient care.
Meet Your Recruiter
Dylan Sefcik
Worksite address
worcester, MA, 01609, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.