Executive Director, Case Management

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. The Executive Director of Case Management provides strategic and operational leadership for the enterprise Case Management program across all Beth Israel Lahey Health (BILH) facilities. This role will lead the transformation of Case Management operations from a decentralized model to an integrated, centralized enterprise function with standardized processes, shared best practices, and consistent performance across all facilities. This executive-level position is responsible for developing and executing comprehensive care coordination strategies that optimize patient throughput, ensure safe and timely transitions of care, reduce avoidable readmissions, and support the organization's population health and value-based care objectives. The Executive Director partners with senior clinical and operational leaders, including the Chief Nursing Officers, Chief Medical Officers, Physician Advisors, Medical Directors payer partners, service line leaders, and post-acute care partners to align care transition initiatives with organizational goals of care coordination and length of stay optimization. Job Description ESSENTIAL DUTIES & RESPONSIBILITIES: Strategic Leadership & Program Development Develop and execute enterprise-wide Case Management strategic plans aligned with BILH's clinical, financial, quality, and population health objectivesLead the evaluation, selection, and management of Case Management technology solutions and vendor partnerships that support care coordination workflowsDesign and operationalize standardized Case Management policies, procedures, and best practices across all BILH facilities, leading the transition from decentralized site-based operations to an integrated enterprise model while ensuring compliance with CMS Conditions of Participation for Discharge PlanningServe as executive sponsor for the Case Management Committee and lead the annual review and implementation of the system-wide Case Management PlanDrive innovation in care coordination models that support contemporary practicesEstablish strategic partnerships with post-acute care providers, community resources, and payer care management teams to optimize transitions and reduce fragmentation Enterprise Integration & Standardization Lead the strategic evolution of Case Management operations from facility-based models to a centralized, standardized enterprise functionAssess current state Case Management practices across all hospitals to identify opportunities for standardization, efficiency gains, and best practice adoptionDevelop and implement a comprehensive change management strategy to transition facilities to standardized Case Management workflows, policies, and performance expectationsCreate governance structures that balance enterprise consistency with facility-specific clinical needsBuild consensus among site-based leadership teams to adopt centralized Case Management processes and shared service modelsEstablish standardized work queues, case assignment methodologies, and productivity expectations across the systemDesign communication strategies to support cultural shifts from site autonomy to enterprise integrationDevelop phased implementation plans that minimize disruption while achieving standardization goalsCreate feedback mechanisms to ensure facility voices are heard throughout the centralization process Care Coordination & Transition Management Oversee enterprise care coordination strategy with accountability for safe, timely, and effective transitions across the continuum of careLead initiatives to optimize patient throughput and reduce length of stay through proactive discharge planning, barrier identification, and escalation processesDevelop and implement complex case management programs for high-risk, high-utilizer, and medically complex patient populationsEnsure integration of psychosocial assessments, social determinants of health screening, and community resource navigation into care coordination workflowsCollaborate with post-acute care partners to ensure appropriate care setting placement, reduce readmissions, and improve patient outcomesPartner with Population Health, Value-Based Care, and ACO teams to align Case Management strategies with risk-based contract requirements and quality metricsCollaborate with Social Work leadership to ensure coordinated support for patients with complex psychosocial needs Regulatory Compliance & Quality Oversight Ensure enterprise-wide compliance with CMS Conditions of Participation for Discharge Planning across all hospitalsOversee compliance with patient choice requirements, Important Message from Medicare (IMM) delivery, and all applicable federal and state discharge planning regulationsLead organizational response to regulatory changes, accreditation surveys, and external reviews related to care coordination and discharge planningCollaborate with Compliance, Legal, Quality, and Patient Experience departments to address care coordination-related risks and findingsMonitor and report on quality metrics related to readmission rates, patient satisfaction with discharge processes, and care transition effectivenessDevelop and implement strategies to reduce avoidable readmissions through enhanced discharge planning, patient education, and post-discharge follow-up Financial & Operational Excellence Oversee Case Management operations across the continuum of care with accountability for length of stay optimization, appropriate level of care placement, and denial reductionPartner with Utilization Management leadership as a peer collaborator to ensure aligned approaches to length of stay optimization and appropriate level of care placementDrive measurable financial impact through reduced avoidable days, impact on length of stay, readmission rates, and patient experience scores. Develop executive-level reporting and dashboards that demonstrate Case Management program value and ROILead business case development for Case Management technology investments and staffing optimizationConduct benchmarking analysis against peer academic medical centers and national standardsManage departmental budget with accountability for resource allocation aligned with organizational priorities Leadership & Talent Development Provide leadership and direction to Case Management leadership and a workforce across the enterprise, including both employed staff and contract laborBuild high-performing teams through strategic recruitment, onboarding, competency assessment, and professional development initiativesEstablish standardized training programs for Case Management staff on care coordination best practices, regulatory requirements, and documentation standards, create career pathways and succession planning for Case Management professionals across the organizationLead organizational change management initiatives related to Case Management process improvements and technology implementationsFoster a culture of collaboration between Case Management staff, utilization management, social work, and clinical teams Clinical & Physician Engagement Cultivate strong collaborative relationships with Chief Nursing Officers, Chief Medical Officers, Physician Advisors, and department chairs across all facilitiesPartner with clinical leadership to address patterns of inappropriate admissions, delayed discharges, or care setting optimization opportunitiesDesign and deliver education to clinical staff and physicians on care coordination best practices, regulatory requirements, and documentation standards for Case ManagementServe as the organizational expert on utilization management best practices, regulatory requirements, and payer policiesLead physician advisor integration into Case Management processes for complex cases and appealsCollaborate with Utilization Management leadership and Physician Advisors on cases requiring coordinated intervention for length of stay optimization Care Coordination & Transition Management Oversee integration of Case Management with discharge planning, case management, and care transitions across the continuumDevelop strategies to reduce length of stay while maintaining quality outcomes and patient satisfactionCollaborate with post-acute care partners to ensure appropriate care transitions and reduce readmissionsLead initiatives to optimize observation services utilization and inpatient admission appropriatenessPartner with Population Health and Value-Based Care teams to align Case Management strategies with risk-based contracts Analytics & Performance Improvement Establish enterprise-wide Case Management dashboards and key performance indicators with actionable insights for executive leadershipUtilize data analytics to identify utilization patterns, outlier variation, discharge barriers, throughput bottlenecks, and opportunities for targeted interventionLead data-driven performance improvement initiatives with measurable outcomes in appropriate resource utilizationTranslate complex utilization data into compelling narratives for diverse stakeholder audiences, including Board presentationsMonitor denial trends in discharge disposition, post-acute utilization, and readmission patterns, implementing corrective action plans as needed Education MINIMUM QUALIFICATIONS: Bachelor's degree in Nursing, Healthcare Administration, Health Information Management, or related healthcare field requiredMaster's degree in Nursing, Healthcare Administration, Public Health, or related field strongly preferred Licensure, Certification & Registration Active RN license preferredActive LCSW/LICSW consideredACM (Accredited Case Manager) ,CCM (Certified Case Manager) or CMGT-BC (Nurse Case Manager Board Certified) strongly preferred Experience Minimum 8 years of progressive leadership experience in Case Management and/or Utilization ManagementMinimum 3 years in senior leadership roles with multi-site responsibilityDemonstrated experience managing teams and achieving measurable operational and financial outcomesExperience with Case Management post acute partnershipsExperience leading regulatory compliance initiatives and responding to external audits Skills, Knowledge & Abilities Executive presence with ability to influence and partner with senior clinical and operational leadershipDeep expertise in care coordination best practices, discharge planning requirements, and transitions of care standards. Comprehensive knowledge of CMS Conditions of Participation for Discharge Planning and related regulatory requirements Strong understanding of post-acute care landscape, including SNF, LTACH, IRF, home health, and hospice level of care criteria Strategic thinking with ability to translate organizational priorities into actionable care coordination initiativesAdvanced analytical skills with ability to interpret length of stay data, readmission patterns, and throughput metrics Experience with Epic EHR and Case Management workflow technologiesExceptional communication skills with ability to present to executive and board-level audiencesChange management expertise with demonstrated success leading process improvement initiativesUnderstanding of value-based care models and their impact on utilization management strategiesBudget development and vendor management experienceProven change management expertise with demonstrated success leading organizational transformation and centralization initiativesAbility to build consensus and influence stakeholders across multiple sites with diverse operational culturesExperience navigating complex political dynamics inherent in transitioning from site autonomy to enterprise standardizationStrong diplomatic skills with ability to balance enterprise efficiency goals with facility-specific needs and concerns Preferred Qualifications Experience in academic medical center or large integrated delivery networkClinical background in acute care nursing, case management, social work, or utilization reviewExperience with AI or predictive analytics applications in care coordination and readmission preventionPublished research or presentations at national conferences (NAUM, ACMA, CMSA)Teaching or training experience in healthcare-related disciplineExperience serving on organizational committees (Quality, Patient Safety, Revenue Cycle) Pay Range $185,000.00 USD - $220,000.00 USD The pay range listed for this position is the annual base salary range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law. As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment. More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger. Equal Opportunity Employer/Veterans/Disabled