Nurse Manager - Case Management

Essential Responsibilities

• Provides day-to-day management and oversight of care transition and case management functions across inpatient and emergency department settings.
• Ensures consistent, high-quality discharge planning and care transition practices aligned with regulatory, payer, and organizational standards.
• Oversees utilization review, denial management, and medical necessity processes to optimize reimbursement and appropriate level of care.
• Maintains established policies, procedures, and performance standards for care transitions and case management services.
• Supervises, coaches, and supports nurse case managers and care transition staff.
• Provides guidance on complex or high-risk cases, escalations, and ethical/regulatory concerns.
• Participates in staff onboarding, education, competency validation, and ongoing performance management.
• Fosters a collaborative and accountable, and patient-centered team culture.
• Builds and sustains collaborative relationships with physicians, nursing leadership, social work, utilization management, and ancillary departments.
• Serves as a clinical and operational resource for providers and leadership regarding care transitions and discharge planning.
• PARTNERS WITH POST-ACUTE FACILITIES, HOME CARE AGENCIES, AND COMMUNITY PROVIDERS TO ENSURE SMOOTH AND SAFE TRANSITIONS OF CARE.
• Ensures compliance with CMS, Conditions of Participation, accreditation standards, and payer requirements.
• Participates in quality improvement initiatives related to readmissions, patient experience, and care coordination outcomes.
• Uses data and metrics (LOS, denials, readmissions, throughput) to guide performance improvement strategies.
• SUPPORTS AUDITS, REGULATORY REVIEWS, AND PROCESS IMPROVEMENT INITIATIVES RELATED TO CARE TRANSACTIONS.
• Assists in staffing oversight, scheduling support, and workload management.
• CONTRIBUTES TO POLICY DEVELOPMENT, PROGRAM PLANNING, AND DEPARTMENTAL GOALS.
• PROVIDES REPORTS AND UPDATES TO SENIOR LEADERSHIP RELATED TO PERFORMANCE METRICS AND OPERATIONAL NEEDS.

Required Education & Experience

• Registered Nurse (RN) with current Massachusetts licensure.
• Bachelor of Science in Nursing (BSN) preferred.
• Five (5) or more years of hospital based case management or care coordination experience.
• Five (5) or more years of acute care medical/surgical experience.
• Demonstrated knowledge of utilization review, denial management, and discharge planning workflows.
• Prior leadership or management experience strongly preferred.

Preferred Certifications

• Certified Case Manager (CCM) or equivalent certification preferred.

Key Competencies

• Strong leadership, communication, and organizational skills.
• Ability to manage complex clinical and operational issues.
• High level of collaboration and professionalism.
• Knowledge of payer requirements, compliance standards, and care transition best practices.
• Commitment to patient centered care and quality outcomes.

Pay Range

$125,000.00 USD – $188,000.00 USD