The individual in this position has overall responsibility for hospital utilization management, transition management, and operational management of the Case Management Department in order to promote effective utilization of hospital resources, timely and accurate revenue cycle processes, denial prevention, safe and timely patient throughput, and compliance with all state and federal regulations related to case management services. This position integrates national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention; Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction; Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care; Compliance with state and federal regulatory requirements, TJC accreditation standards, and Tenet policy; and Education provided to physicians, patients, families, and caregivers

Manage department operations to assure effective throughput and reimbursement for services provided
Lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement
Ensure medical necessity and revenue cycle processes are completed accurately and in compliance with CMS regulations and Tenet policy
Ensure timely and effective patient transition and planning to support efficient patient throughput
develop and provide physician education and feedback on hospital utilization
other duties as assigned.

Are you a results-driven leader ready to make a meaningful impact to patients, caregivers, and your community? At Saint Vincent Hospital hospital, were seeking an innovative and experienced healthcare leader to drive excellence and inspire our team towards exceptional patient outcomes and operational success.

At Saint Vincent Hospital, we understand that our greatest asset is our dedicated team of professionals. That's why we offer more than a job - we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include:

Medical, dental, vision, and life insurance
401(k) retirement savings plan with employer match
Generous paid time off
Career development and continuing education opportunities
Health savings accounts, healthcare & dependent flexible spending accounts
Employee Assistance program, Employee discount program
Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance

Note: Eligibility for benefits may vary by location and is determined by employment status

Saint Vincent Hospital has been providing high-quality healthcare to Worcester and the surrounding communities for more than 125 years. At Saint Vincent Hospital, we believe you should have access to the treatments you need without having to travel far from home. We are proud to have been the first hospital in central Massachusetts to offer robotically assisted surgical procedures and minimally invasive, computer-assisted joint replacements. Some of the distinctions we have received include designations as a Blue Distinction Center for Cardiac Services, Bariatric Surgery, and both Knee and Hip Replacement. We continue to be leaders in advanced treatments like ourCyberKnife Radiosurgery, and our Cardiac Rehabilitation Program whichoffers a unique, specialized approach to overcoming heart health challenges. Healthgrades awarded Saint Vincent Hospital #1 in Cardiology in the state and one of Americas 100 Best Hospitals for Coronary Intervention in 2023 and 2024, which puts Saint Vincent Hospital in the top 5% of hospitals nationwide for coronary intervention. At Saint Vincent Hospital, you can grow your career skills through a wide range of specialties and help support the overall health of our community. Join our team!

Required:
- Education: Bachelor's degree in Business, Nursing or Health Care Administration for RN or Master's in Social Work for MSW
- Experience: 3 years of acute hospital case management or healthcare leadership experience

Licensure/Certification:
- Registered Nurse or LCSW/LMSW license.
- Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy.
- Active RN or LCSW/LMSW license for state(s) covered.
Preferred:
- Experience: 5 years of acute hospital case management leadership multi-site experience
- Education: MSN, MBA, MSW, or MHA
- Licensure/Certification: Accredited Case Manager (ACM)

Director of Case Management

Director of Case Management