Executive Director, Case Management

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.

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

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

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

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

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

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

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

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

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

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

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

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