Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Director of Case Management

Location:

Worcester, MA

Employment Type:

Full Time

Work Setting:

Onsite

Lead Hospital Case Management & Patient Flow

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