Director of Case Management

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 Overvie

wWheeler 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 Responsibilitie

sCase Management Leadership & Operation

• sOversee daily operations of the hospital Case Management Departmen
• tManage staffing levels, workflow distribution, and departmental productivity across seven-day operation
• sLead case management staff development, onboarding, competency evaluations, and performance review
• sConduct departmental meetings and ongoing education initiative
• sSupport recruitment, coaching, corrective actions, and employee engagement activitie
• sAssist with department budgeting, operational planning, and performance improvement initiative

sUtilization Managemen

• tOversee hospital utilization review processes to ensure appropriate patient status, level of care, and medical necessity complianc
• eMonitor compliance with CMS regulations, accreditation standards, and internal case management policie
• sLead denial prevention initiatives and support payer communication processe
• sMonitor avoidable days, throughput metrics, and utilization trends to identify opportunities for operational improvemen
• tParticipate in revenue cycle meetings and support denial management and reimbursement optimization effort
• sSupport physician advisor review processes and peer-to-peer payer escalation

sTransition Planning & Care Coordinatio

• nEnsure transition planning assessments are completed within required timeline
• sSupport discharge planning and patient placement coordination activitie
• sCollaborate with nursing leadership, physicians, ancillary departments, and external providers to ensure efficient patient throughpu
• tMonitor care coordination documentation and transition planning complianc
• eParticipate in daily bed management and complex case review discussion
• sPromote safe, timely, and patient-centered discharge planning processe

sRegulatory Compliance & Qualit

• yEnsure compliance with federal, state, and accreditation standards impacting case management operation
• sMaintain compliance with CMS Conditions of Participation and regulatory requirement
• sMonitor departmental adherence to utilization review procedures and documentation standard
• sSupport implementation of audit recommendations and quality improvement initiative
• sDevelop and maintain departmental policies, procedures, and operational protocol

sEducation & Trainin

• gProvide education to physicians and interdisciplinary teams regarding medical necessity, utilization management, and regulatory complianc
• eLead ongoing staff education related to case management best practices and utilization review standard
• sSupport training initiatives related to InterQual criteria, documentation standards, and patient throughput processe
• sFoster a culture of collaboration, accountability, and continuous improvemen

tRequired Qualification

sEducatio

• nBachelor’s degree in Nursing, Healthcare Administration, Business, or related healthcare field require
• dMaster of Social Work (MSW) required for Social Work candidate
• sMaster’s degree in Nursing, Business Administration (MBA), or Healthcare Administration (MHA) preferre

dLicensur

• eActive Registered Nurse (RN) license OR active LCSW/LMSW license require

dExperienc

• e3–5 years of acute care hospital case management leadership experience require
• d5+ years of acute hospital case management experience preferre
• dExperience with utilization management, denial prevention, discharge planning, and patient throughput initiatives require
• dInterQual® experience preferre
• dBusiness planning and operational management experience preferre

dPreferred Certification

• sAccredited Case Manager (ACM) certification preferre

dRequired Skills & Competencie

• sStrong leadership and team management skill
• sKnowledge of utilization management, care coordination, discharge planning, and reimbursement processe
• sStrong understanding of CMS regulations, Joint Commission standards, and hospital accreditation requirement
• sExcellent communication, presentation, and relationship-building abilitie
• sAnalytical and problem-solving skills with the ability to interpret utilization and operational dat
• aExperience managing multiple priorities in a fast-paced acute care hospital environmen
• tStrong project management and performance improvement capabilitie
• sAbility to collaborate effectively with physicians, nursing leadership, revenue cycle teams, payers, and interdisciplinary staf
• fExperience with EMR training and utilization analytics and reporting tools preferre

d
Why Work With Wheeler Staffing Partner

s?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 car