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 objectives
• Lead the evaluation, selection, and management of Case Management technology solutions and vendor partnerships that support care coordination workflows
• Design 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 Planning
• Serve as executive sponsor for the Case Management Committee and lead the annual review and implementation of the system-wide Case Management Plan
• Drive innovation in care coordination models that support contemporary practices
• Establish 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 function
• Assess current state Case Management practices across all hospitals to identify opportunities for standardization, efficiency gains, and best practice adoption
• Develop and implement a comprehensive change management strategy to transition facilities to standardized Case Management workflows, policies, and performance expectations
• Create governance structures that balance enterprise consistency with facility-specific clinical needs
• Build consensus among site-based leadership teams to adopt centralized Case Management processes and shared service models
• Establish standardized work queues, case assignment methodologies, and productivity expectations across the system
• Design communication strategies to support cultural shifts from site autonomy to enterprise integration
• Develop phased implementation plans that minimize disruption while achieving standardization goals
• Create 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 care
• Lead initiatives to optimize patient throughput and reduce length of stay through proactive discharge planning, barrier identification, and escalation processes
• Develop and implement complex case management programs for high-risk, high-utilizer, and medically complex patient populations
• Ensure integration of psychosocial assessments, social determinants of health screening, and community resource navigation into care coordination workflows
• Collaborate with post-acute care partners to ensure appropriate care setting placement, reduce readmissions, and improve patient outcomes
• Partner with Population Health, Value-Based Care, and ACO teams to align Case Management strategies with risk-based contract requirements and quality metrics
• Collaborate 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 hospitals
• Oversee compliance with patient choice requirements, Important Message from Medicare (IMM) delivery, and all applicable federal and state discharge planning regulations
• Lead organizational response to regulatory changes, accreditation surveys, and external reviews related to care coordination and discharge planning
• Collaborate with Compliance, Legal, Quality, and Patient Experience departments to address care coordination-related risks and findings
• Monitor and report on quality metrics related to readmission rates, patient satisfaction with discharge processes, and care transition effectiveness
• Develop 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 reduction
• Partner with Utilization Management leadership as a peer collaborator to ensure aligned approaches to length of stay optimization and appropriate level of care placement
• Drive 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 ROI
• Lead business case development for Case Management technology investments and staffing optimization
• Conduct benchmarking analysis against peer academic medical centers and national standards
• Manage 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 labor
• Build high-performing teams through strategic recruitment, onboarding, competency assessment, and professional development initiatives
• Establish 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 organization
• Lead organizational change management initiatives related to Case Management process improvements and technology implementations
• Foster 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 facilities
• Partner with clinical leadership to address patterns of inappropriate admissions, delayed discharges, or care setting optimization opportunities
• Design and deliver education to clinical staff and physicians on care coordination best practices, regulatory requirements, and documentation standards for Case Management
• Serve as the organizational expert on utilization management best practices, regulatory requirements, and payer policies
• Lead physician advisor integration into Case Management processes for complex cases and appeals
• Collaborate 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 continuum
• Develop strategies to reduce length of stay while maintaining quality outcomes and patient satisfaction
• Collaborate with post-acute care partners to ensure appropriate care transitions and reduce readmissions
• Lead initiatives to optimize observation services utilization and inpatient admission appropriateness
• Partner 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 leadership
• Utilize data analytics to identify utilization patterns, outlier variation, discharge barriers, throughput bottlenecks, and opportunities for targeted intervention
• Lead data-driven performance improvement initiatives with measurable outcomes in appropriate resource utilization
• Translate complex utilization data into compelling narratives for diverse stakeholder audiences, including Board presentations
• Monitor denial trends in discharge disposition, post-acute utilization, and readmission patterns, implementing corrective action plans as needed

MINIMUM QUALIFICATIONS:

Education:

• Bachelor's degree in Nursing, Healthcare Administration, Health Information Management, or related healthcare field required
• Master's degree in Nursing, Healthcare Administration, Public Health, or related field strongly preferred

Licensure, Certification & Registration:

• Active RN license preferred
• Active LCSW/LICSW considered
• ACM (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 Management
• Minimum 3 years in senior leadership roles with multi-site responsibility
• Demonstrated experience managing teams and achieving measurable operational and financial outcomes
• Experience with Case Management post acute partnerships
• Experience 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 leadership

• Deep 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 initiatives
• Advanced analytical skills with ability to interpret length of stay data, readmission patterns, and throughput metrics Experience with Epic EHR and Case Management workflow technologies
• Exceptional communication skills with ability to present to executive and board-level audiences
• Change management expertise with demonstrated success leading process improvement initiatives
• Understanding of value-based care models and their impact on utilization management strategies
• Budget development and vendor management experience
• Proven change management expertise with demonstrated success leading organizational transformation and centralization initiatives
• Ability to build consensus and influence stakeholders across multiple sites with diverse operational cultures
• Experience navigating complex political dynamics inherent in transitioning from site autonomy to enterprise standardization
• Strong 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 network
• Clinical background in acute care nursing, case management, social work, or utilization review
• Experience with AI or predictive analytics applications in care coordination and readmission prevention
• Published research or presentations at national conferences (NAUM, ACMA, CMSA)
• Teaching or training experience in healthcare-related discipline
• Experience 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